Perceived barriers to the use of sedation protocols and daily sedation interruption: A multidisciplinary survey

Tanios, Maged; Wit, Marjolein de; Epstein, Scott K.; Devlin, John W.

doi:10.1016/j.jcrc.2008.03.037

Cited by 136 publications

(132 citation statements)

References 35 publications

Supporting

Mentioning

119

Contrasting

Unclassified

Order By: Relevance

“…First, the response rate to our questionnaire was 43%. While this response rate is within the range of other recently published surveys of critical care professionals [37][38][39][40], our study could certainly be limited by sampling bias. Regarding the potential for sampling bias, the large proportion of female questionnaire-recipients (95%), and respondents (94%), is consistent with existing data showing that 96% of United States SLPs are female [14].…”

Section: Discussionmentioning

confidence: 55%

Diagnosis And Treatment Of Post-Extubation Dysphagia: Results From A National Survey

Macht

Wimbish

Clark

et al. 2012

A46. Intensive Care Unit Management and Rapid Response: Provider and Patient Outcomes

View full text Add to dashboard Cite

Purpose-This study sought to determine the utilization of speech-language pathologist (SLPs) for the diagnosis and treatment of post-extubation dysphagia in survivors of mechanical ventilation.Methods-We designed, validated, and mailed a survey to 1,966 inpatient SLPs who routinely evaluate patients for post-extubation dysphagia.Results-The majority of SLP diagnostic evaluations (60%; 95% CI = 59-62%) were performed using clinical techniques with uncertain accuracy. Instrumental diagnostic tests (such as fluoroscopy and endoscopy) are more likely to be available at university than community hospitals. After adjusting for hospital size and academic affiliation, instrumental test use varied significantly by geographical region. Treatments for post-extubation dysphagia usually involved dietary adjustment (76%; 95% CI = 73-79%) and postural changes/compensatory maneuvers (86%; 95% CI = 84-88%), rather than on interventions aimed to improve swallowing function (24%; 95% CI = 21-27%).

show abstract

Section: Discussionmentioning

confidence: 55%

Diagnosis And Treatment Of Post-Extubation Dysphagia: Results From A National Survey

Macht

Wimbish

Clark

et al. 2012

A46. Intensive Care Unit Management and Rapid Response: Provider and Patient Outcomes

View full text Add to dashboard Cite

show abstract

“…factors, lack of familiarity of resident physicians with the protocols, physicians' personal preference, lack of nursing support, and fear of oversedation have been cited as reasons associated with noncompliance with protocols. 18,30,31 When examining use of protocols, it has been reported that practitioners working in larger or university-affiliated ICUs are more likely to use sedation or pain protocols, 32 and protocol use ranges from 20% to 90%. 18,[30][31][32][33] Actual adherence, however, ranges from 20% to 58%.…”

Section: Discussionmentioning

confidence: 99%

The Role of Standardized Protocols in Unplanned Extubations in a Medical Intensive Care Unit

Jarachovic

Mason

Kerber

et al. 2011

American Journal of Critical Care

View full text Add to dashboard Cite

Background Many patients admitted to medical intensive care units require mechanical ventilation to assist with respiratory management. Unplanned extubations of these patients are associated with poor outcomes for patients and organizations. No previous research has investigated the role of standardized protocols in unplanned extubations when examined in conjunction with traditional risk factors. Objective To identify risk factors associated with unplanned extubation among patients receiving mechanical ventilation and determine degree of compliance with pain, sedation, and weaning protocols. Methods A prospective cohort study design was used. Data on all patients admitted to the medical intensive care unit who required mechanical ventilation were gathered daily. Additional data were gathered on those patients who experienced unplanned extubation. Descriptive, correlational, and regression analyses were performed. Results Weaning protocols were a significant predictor of unplanned extubation: patients who had weaning protocols ordered and followed were least likely to experience unplanned extubation. Only 10% of the 190 patients in the study required reintubation, resulting in a significantly shorter ventilation time and unit length of stay among the unplanned extubation group. Conclusions Weaning protocols were associated with decreased incidence of unplanned extubation. Use of standardized protocols was feasible, as compliance among health care providers was high when protocols were medically prescribed. The reintubation rate in this study was low and associated with a significantly shorter ventilatory period and unit length of stay in the unplanned extubation group. (American Journal of Critical Care. 2011;20:304- Within our institution, an ongoing quality improvement project indicated that unplanned extubation continued to occur despite implementation of sedation, pain management, and weaning protocols that addressed factors reported in the literature to be associated with unplanned extubation. Additional investigation was needed to explore factors associated with unplanned extubation. Therefore, a research project was initiated with the following study aims: (1) to identify factors associated with unplanned extubation among patients admitted to the MICU who are receiving mechanical ventilation and (2) to determine the degree of compliance of physicians and nurses with sedation, pain, and weaning protocols.

show abstract

“…Th e use of daily interruption for patients receiving continuous infusions occurs inconsistently, with surveys reporting 40 to 62% rates of compliance [38][39][40][41]. In addition, despite the perception that sedation scales are benefi cial, only 47-60% of ICUs had implemented sedation protocols at the time of the survey [39][40][41], and 85.6% of physicians in a Brazilian survey indeed believed their patients were usually over-sedated [41]. Th e same survey reported sedation levels being assessed 2 times or less per day in over 50% of patients.…”

Section: Practical Considerationsmentioning

confidence: 99%

‘Cooperative Sedation’: Optimizing Comfort while Maximizing Systemic and Neurological Function

Goodwin¹,

Lewin²,

Mirski³

2012

Annual Update in Intensive Care and Emergency Medicine

View full text Add to dashboard Cite

Perceived barriers to the use of sedation protocols and daily sedation interruption: A multidisciplinary survey

Cited by 136 publications

References 35 publications

Diagnosis And Treatment Of Post-Extubation Dysphagia: Results From A National Survey

Diagnosis And Treatment Of Post-Extubation Dysphagia: Results From A National Survey

The Role of Standardized Protocols in Unplanned Extubations in a Medical Intensive Care Unit

‘Cooperative Sedation’: Optimizing Comfort while Maximizing Systemic and Neurological Function

Contact Info

Product

Resources

About