The Use of Continuous IV Sedation Is Associated With Prolongation of Mechanical Ventilation

Kollef, Marin H.; Levy, N; Ahrens, Tom; Schaiff, Robyn; Prentice, Donna; Sherman, Glenda

doi:10.1378/chest.114.2.541

Cited by 800 publications

(443 citation statements)

References 36 publications

(41 reference statements)

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“…Nursedirected protocols that incorporate a sedation scale likely result in improved outcomes; however, the benefit depends on the existing local culture and practice [435,436]. Another option for systematically limiting the use of sedation is the administration of intermittent rather than continuous sedation [437,438]. Daily sedation interruption (DSI) was associated with improved outcomes in a single-center randomized trial compared with usual care [430]; however, in a multicenter RCT there was no advantage to DSI when patients were managed with a sedation protocol, and nurses perceived a higher workload [439].…”

Section: We Recommend That Continuous or Intermittent Sedation Be Minmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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Objective: To provide an update to "Surviving Sepsis Campaign Guidelines for Management of Sepsis and Septic Shock: 2012". Design:A consensus committee of 55 international experts representing 25 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict-of-interest (COI) policy was developed at the onset of the process and enforced throughout. A stand-alone meeting was held for all panel members in December 2015. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. Methods:The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.

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Section: We Recommend That Continuous or Intermittent Sedation Be Minmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

et al. 2017

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“…Benzodiazepine regimens using high doses have been found to be associated with substantial morbidity and prolonged hospitalizations. 16,17 In a series of small studies, Addolorato's research team has reported decreases in AWS symptoms in association with the use of low doses of baclofen in an outpatient population, 18 and has found baclofen to be associated with reduced alcohol craving in the long-term management of alcohol dependence. 11,19,20 Addolorato and colleagues' studies of baclofen in relieving AWS symptoms prompted our group to apply the use of baclofen in a larger group of inpatients with AWS.…”

mentioning

confidence: 99%

Treating alcohol withdrawal with oral baclofen: A randomized, double‐blind, placebo‐controlled trial

Lyon

Khan

Gessert

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:Abrupt cessation of alcohol intake causes habituated drinkers to experience symptoms of alcohol withdrawal syndrome (AWS).OBJECTIVE:To determine the effect of the gamma‐aminobutyric acid (GABA)‐B agonist baclofen on the course of acute symptomatic AWS.DESIGN:Prospective, randomized, double‐blind, placebo‐controlled clinical study.SETTING:Two tertiary‐care hospitals in Duluth, Minnesota.PATIENTS:Inpatient adults admitted for any reason (including AWS) judged to be at high risk for AWS.INTERVENTION:Inpatients who developed symptoms of AWS received symptom‐triggered benzodiazepine treatment using lorazepam by standard protocol, and were randomized to receive baclofen 10 mg or placebo, 3 times per day, orally.MEASUREMENTS:AWS severity was assessed using the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA‐Ar); lorazepam dose was monitored.RESULTS:Seventy‐nine subjects were enrolled. The 44 subjects who developed symptoms of AWS were randomized to baclofen or placebo. Thirty‐one subjects (18 baclofen, 13 placebo) completed 72 hours of assessments, either entirely as inpatients or with outpatient follow‐up. The need for high doses of benzodiazepines (20 mg or more of lorazepam over 72 hours) to control AWS was less likely in the baclofen treatment group (1 of 18) than in the placebo‐treated group (7 of 13) (P = 0.004).CONCLUSIONS:We found that the use of baclofen was associated with a significant reduction in the use of high doses of benzodiazepine (lorazepam) in the management of symptomatic AWS. The use of low‐dose baclofen in the management of AWS deserves further study, as reduced dependence on high‐dose benzodiazepines in AWS management could improve patient safety. Journal of Hospital Medicine 2011;6:474–479. © 2011 Society of Hospital Medicine

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“…In these studies, the non-use of protocol has made the time of extubation become inaccurate, resulting in early extubation and unnecessary prolongation of the duration of the weaning process [5,6,13,[16][17][18][19][20][21][22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…Several randomized controlled trials in hospitalized patients in general intensive care demonstrated reduction of the period in which patients used to be on mechanical ventilation, lower rates of reintubation and fewer complications when weaning from MV was performed according to specific protocol [5,6,13,[16][17][18][19][20][21][22][23]28].…”

Section: Discussionmentioning

confidence: 99%

Efeitos da aplicação de protocolo de desmame de ventilação mecânica em Unidade Coronária: estudo randomizado

Piotto¹,

Maia²,

Machado³

et al. 2011

Rev Bras Cir Cardiovasc

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The Use of Continuous IV Sedation Is Associated With Prolongation of Mechanical Ventilation

Cited by 800 publications

References 36 publications

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

Treating alcohol withdrawal with oral baclofen: A randomized, double‐blind, placebo‐controlled trial

Efeitos da aplicação de protocolo de desmame de ventilação mecânica em Unidade Coronária: estudo randomizado

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