The Effect of Daily Sedation-Weaning Application on Morbidity and Mortality in Intensive Care Unit Patients

Abstract

Background/aimsSedation is one of the most important components of intensive care unit (ICU) in patients who are mechanically ventilated at intensive care conditions. As a result of sedation and analgesia in the intensive care unit, the patient is to be awakened a comfortable and easy process. The aim of the study is to demonstrate the effects of day-time sedation interruptions in intensive care patients.Material and methodsWe made a retrospective review of 100 patients who were monitored, mechanically ventilated and treated at our intensive care unit between January 2008 and January 2013. Patients were divided into two groups, including Group P (continuous infusion of sedative agent) and Group D (daily sedation interruptions - daily recovery).Demographics, mechanical ventilation time, stay at intensive care unit, hospitalization period, time of first weaning, success of weaning, ventilator-related pneumonia (VRP), total doses of drugs, re-intubation frequency, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) scores and mortality rates of patients were compared. Ramsay Sedation Score (RSS) was used to evaluate the level of sedation. Considering that ideal sedation level is "3" with RSS, RSS < 3 is considered as mild sedation, while RSS > 3 is considered as deep sedation.ResultsThere was no difference between demographics of patients. Mechanical ventilation period was significantly longer in Group P than Group D (p < 0.001). When stay at ICU unit was considered, ICU stay was significantly longer in Group P than Group D (p < 0.001). No statistically significant difference was found between two groups with respect to hospitalization period. In inter-group comparison, time to start first weaning was significantly late in Group P than Group D (p < 0.05). There was no difference between groups in terms of frequency of success of weaning and mortality rate (p > 0.05). In inter-group comparison the frequency of reintubation viewed in Group D was significantly less than in Group P (p < 0.05). Considering development of VRP, it was significantly more common in Group P in comparison with Group D (p < 0.05). No statistically significant difference was found between groups in terms of doses of sedative agents (p > 0.05). Considering doses of opioid analgesics, the total dose of fentanyl was significantly higher in Group P than Group D (p = 0.04), while no difference was found for doses of morphine (p > 0.05). Again, no statistical difference was found in doses of muscle relaxant agents (p > 0.05).ConclusionIt was observed that the sedation technique with daily interruption is superior to continuous infusion of sedatives. Accordingly, we believe that daily weaning will make positive contributions to patients who are mechanically ventilated at intensive care unit.

Daily sedation interruption and mechanical ventilation weaning: a literature review

“…There have been, however, some distinguished studies that have been conducted in this field that applied some sort of blinding process, and for that reason, we believe their separate presentation is in order. Therefore, in our supplementary material we describe four studies [41][42][43][44] that, albeit noteworthy, did not meet the criteria for inclusion in our review.…”

“…Our study has a strong point that derives from the inclusion of 2 trials [34,41] that incorporated dexmedetomidine into the DSI protocol and, to the best of our knowledge, have never been formerly reviewed or were intentionally excluded because they did not fit the study's criteria for inclusion. For example, such was the case for the trial by Yilmaz et al [34] that was excluded in the meta-analysis by the Mayo Foundation because the control groups underwent protocolized sedation instead of being sedated at the physicians' discretion.…”

Impacto da interrupção diária de sedação na morbimortalidade de pacientes críticos

“…Essa situação pode causar manifestações clínicas como intensa ansiedade e agitação no paciente. Para aumentar a adesão ao tratamento e reduzir essa ansiedade e dor, sedativos e analgésicos são utilizados em pacientes ligados a ventiladores mecânicos (VM) em unidades de terapia intensiva (UTI) (KAYIR et al, 2018).…”

“…Malefícios ainda mais relevantes num cenário de instabilidade hemodinâmica, disfunção de órgãos e absorção inconsistente -condições clínicas comuns em pacientes críticos (TANAKA et al, 2014). Devido a isso, basicamente três métodos foram incorporados para racionalizar a administração de sedação em pacientes críticos que recebem tratamento de ventilação mecânica: a primeira e mais comum maneira é interromper a sedação durante o dia para reavaliar dose de infusão e descontinuidade (interrupção diária); outra é a redução progressiva da infusão de sedoanalgesia de acordo com o quadro clínico e os escores de sedação após o exame do paciente; por fim, o outro método é usar os escores de sedação de preferência da equipe médica como referencial, e aplicar sedativos de forma intermitente, conforme a percepção de necessidade (KAYIR et al, 2018).…”

The Effect of Programmed Analgesia and Sedation Combined with Nursing Intervention on Weaning Extubation of Intensive Care Unit Patients

“…Analgesia and sedation, as the basic treatment for mechanically ventilated patients in ICU, can improve patient comfort, reduce anxiety, promote nursing and adapt to assisted ventilation [8] . However, inappropriate analgesia and sedation can prolong the patient's MV time, increase the incidence of ventilator-associated pneumonia (VAP), deep vein thrombosis, accidental extubation and the patient's painful memories during ICU treatment reaction [9][10][11] .…”