ProCT is not a better marker of infection than CRP in critically ill patients, but it can represent a useful adjunctive parameter to identify infection and is a useful marker of the severity of infection.
IntroductionDeep sedation in critically ill patients is associated with a longer duration of
mechanical ventilation and a prolonged length of stay in the intensive care unit.
Several protocols have been used to improve these outcomes. We implement and
evaluate an analgesia-based, goal-directed, nurse-driven sedation protocol used to
treat critically ill patients who receive mechanical ventilation. MethodsWe performed a prospective, two-phase (before-after), non-randomized multicenter
study that involved 13 intensive care units in Chile. After an observational phase
(observational group, n=155), we designed, implemented and evaluated an
analgesia-based, goal-directed, nurse-driven sedation protocol (intervention
group, n=132) to treat patients who required mechanical ventilation for more than
48 hours. The primary outcome was to achieve ventilator-free days by day 28. ResultsThe proportion of patients in deep sedation or in a coma decreased from 55.2% to
44.0% in the interventional group. Agitation did not change between the periods
and remained approximately 7%. Ventilator-free days to day 28, length of stay in
the intensive care unit and mortality were similar in both groups. At one year,
post-traumatic stress disorder symptoms in survivors were similar in both groups.
ConclusionsWe designed and implemented an analgesia-based, goal-directed, nurse-driven
sedation protocol in Chile. Although there was no improvement in major outcomes,
we observed that the present protocol was safe and feasible and that it resulted
in decreased periods of deep sedation without increasing agitation.
Background: The outcome of mechanically ventilated patients can be influenced by factors such as the indication of mechanical ventilation (MV) and ventilator parameters. Aim: To describe the characteristics of patients receiving MV in Chilean critical care units. Material and methods: Prospective cohort of consecutive adult patients admitted to 19 intensive care units (ICU) from 9 Chilean cities who received MV for more than 12 hours between September 1st, 2003, and September 28th, 2003. Demographic data, severity of illness, reason for the initiation of MV, ventilation modes and settings as well as weaning strategies were registered at the initiation and then, daily throughout the course of MV for up to 28 days. ICU and hospital mortality were recorded. Results: Of 588 patients admitted, 156 (26.5%) received MV (57% males). Mean age and Simplified Acute Physiology Score-II (SAPS II) were 54.6±18 years and 40.6±16.4 points respectively. The most common indications for MV were acute respiratory failure (71.1%) and coma (22.4%). Assist-control mode (71.6%) and synchronized intermittent mandatory ventilation (SIMV) (14,2%) were the most frequently used. T-tube was the main weaning strategy. Mean duration of MV and length of stay in ICU were 7.8±8.7 and 11.1±14 days respectively. Overall ICU mortality was 33.9% (53 patients). The main factors independently associated with increased mortality were (1) SAPS II ≥ 60 points (Odds Ratio (OR), 10.5; 95% CI, 1.04-106.85) and (2) plateau pressure ≥ 30 cm H 2 0 at second day (OR, 3.9; 95% CI, 1.17-12.97). Conclusions: Conditions present at the onset of MV and ventilator management were similar to those reported in the literature. Magnitude of multiorgan dysfunction and high plateau pressures are the most important factors associated with mortality (Rev Méd Chile 2008; 136: 959-67).
Sedatives were frequently employed and deep sedation was common. Midazolam and fentanyl were the most frequently administered drugs. The use of NMB might be independently associated to greater mortality.
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