μImpact of a nursing-driven sedation protocol with criteria for infusion initiation in the surgical intensive care unit

The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study

“…In this study, protocols with analgosedation algorithms were not found to optimize aspects such as monitoring of pain and sedation, and did not lead to more alert and cooperative patients with less delirium and more mobility, and these aspects were indeed found by other authors. [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] Incorrect implementation of recommendations could explain this difference. 1 Pain monitoring in this study (16.4%) was lower than the 30% rate reported by Luetz et al 34 in a study on ventilated patients, and a long way behind the 67.5% rate reported in the Spanish ASCyD project for patients with and without IMV.…”

“…Other studies have reached the same conclusion regarding the low use of pain assessment tools in non-communicative patients. 24,35,37,57 Various authors [58][59][60] 42 [35][36][37][38][39][40][41][42][43][44] 29 0.01 22 [21][22][23][24] 41 <0.001 24 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] 40 [25][26][27][28][29][30][31][32][33][34][35][36][37][38]…”

“…These protocols are also widely implemented in the literature. 42,[44][45][46][47][48][49][50][51][52][53][54][55][56] Similarly, nurse-guided drug algorithms are widely reported to be effective, 42,[44][45][46][47][48][49][50][51][52][53][54][55][56] although in our setting, drug algorithms are physician-guided. 24 Despite limited adherence to the recommendations in these protocols, our study found greater use of opioids and dexmedetomidine to promote light sedation, as corroborated in a study by Faust et al 45 In our study, benzodiazepines were used more in boluses as rescue therapy to control agitation, and were always followed by IVI dose adjustments to attain the predefined target.…”

“…However, IVI drug titration appears to have been performed incorrectly, because sedative doses did not decrease, unlike findings in other studies. 42,44,45,47,48,50,53,54,56 Bundle recommendations concerning choice of analgesic and sedative drugs prioritize analgesia, and encourage light sedation and avoidance of benzodiazepines because of their deliriogenic effect. 1,8,58 Unlike other authors' findings, [37][38][39]67,68 our findings show that ICUs implement these recommendations, in line with several publications that show a decrease in benzodiazepine use and an increase in propofol and dexmedetomidine use.…”

Different depths of sedation versus risk of delirium in adult mechanically ventilated patients: A systematic review and meta-analysis

“…A second retrieval for the selected literature reports was conducted by reviewing their references and other related literature. We ultimately enrolled 18 studies reporting a correlation between different sedation depths and risk of delirium [14][15][16][17][18][19][28][29][30][31][32][33][34][35][36][37][38][39], that included 10 RCTs, four before-after controlled trials, two prospective cohort studies, and two retrospective studies (Fig 1). Table 1 presents the general profiles of the studies enrolled.…”