Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation

Background: Sedatives and analgesic drugs give comfort and allow adequate respiratory support to critically ill patients in mechanical ventilation (MV). Its improper use may increase the duration of MV. Clinical guidelines suggest implementation of nurse-applied guided by protocol administration protocol, however this is seldom done in clinical practice. Aim: To compare in MV patients, nurse-applied guided by protocol administration of sedatives and analgesic drugs (protocol: group P) with the habitual practice using physicians criteria (control: group C). Material and methods: Inclusion criteria was the need of MV more than 48 b. The exclusion criteria were acute neurological diseases, hepatic cirrohossis, chronic renal failure and limitation of therapeutic efforts. Midazolam and fentanlyl were used in both groups. The level of sedation was monitored with the sedation Agitation Scale (SAS). In the P group, trained nurses applied algorithms to ajust the sedatives doses according to a predefined SAS goal. Results: Forty patients were included, 22 aged 65 +/- 19 years in group P and 18 aged 54 +/- 21 years in group C. Apache II scores were 16 +/- 8 and 19 +/- 8 in each group. SAS score was more frequently evaluated within goal boundaries in group P than in group C (44% and 32%, respectively, P =0.001). No differences in the proportion of patients with inadquate sedation were observed between treatment groups. Midazolam doses were lower in P than in C group (0.04(0.02-0.07) and 0.06(0.030-0.08) mg/kg/h respectively, p =0.005). Conclusions: The implementation of sedation protocol applied by nurses improved the quality of sedation and reduced the dosees midazolam in mechanically ventilated patents (Rev Med Chile 2008; 136: 711-18).