Sedation and weaning from mechanical ventilation: effects of process optimization outside a clinical trial.
PURPOSE: We studied the effects of reorganization and changes in the care process, including use of protocols for sedation and weaning from mechanical ventilation, on the use of sedative and analgesic drugs and on length of respiratory support and stay in the intensive care unit (ICU). MATERIALS AND...
| Publicado en: | Journal of Critical Care Vol. 22; no. 3; pp. 219 - 229 |
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| Autores principales: | , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Sep2007
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105848194&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105848194 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 08839441 1YR jtl: Journal of Critical Care issn: 08839441 maglogo: N pubinfo: dt: Sep2007 vid: 22 iid: 3 pid: 82545 pub: Elsevier B.V. place: Philadelphia, Pennsylvania artinfo: ui: 105848194 105848194 2009680227 10.1016/j.jcrc.2007.01.001 NLM17869972 105848194 ppf: 219 ppct: 10 formats: tig: atl: Sedation and weaning from mechanical ventilation: effects of process optimization outside a clinical trial. aug: au: Jakob SM Lubszky S Friolet R Rothen HU Kolarova A Takala J affil: Department of Intensive Care Medicine, University Hospital Bern [Inselspital], CH-3010 Bern, Switzerland. sug: subj: Analgesics Administration and Dosage Hypnotics and Sedatives Administration and Dosage Intensive Care Units Administration Process Assessment (Health Care) Protocols Ventilator Weaning Methods Aged Algorithms APACHE (Acute Physiology and Chronic Health Evaluation) Female Hospital Mortality Male Middle Age Organizational Change Retrospective Design Switzerland Time Factors Ventilator Weaning Utilization Human Aged: 65+ years Middle Aged: 45-64 years Female Male ab: PURPOSE: We studied the effects of reorganization and changes in the care process, including use of protocols for sedation and weaning from mechanical ventilation, on the use of sedative and analgesic drugs and on length of respiratory support and stay in the intensive care unit (ICU). MATERIALS AND METHODS: Three cohorts of 100 mechanically ventilated ICU patients, admitted in 1999 (baseline), 2000 (implementation I, after a change in ICU organization and in diagnostic and therapeutic approaches), and 2001 (implementation II, after introduction of protocols for weaning from mechanical ventilation and sedation), were studied retrospectively. RESULTS: Simplified Acute Physiology Score II (SAPS II), diagnostic groups, and number of organ failures were similar in all groups. Data are reported as median (interquartile range).Time on mechanical ventilation decreased from 18 (7-41) (baseline) to 12 (7-27) hours (implementation II) (P = .046), an effect which was entirely attributable to noninvasive ventilation, and length of ICU stay decreased in survivors from 37 (21-71) to 25 (19-63) hours (P = .049). The amount of morphine (P = .001) and midazolam (P = .050) decreased, whereas the amount of propofol (P = .052) and fentanyl increased (P = .001). Total Therapeutic Intervention Scoring System-28 (TISS-28) per patient decreased from 137 (99-272) to 113 (87-256) points (P = .009). Intensive care unit mortality was 19% (baseline), 8% (implementation I), and 7% (implementation II) (P = .020). CONCLUSIONS: Changes in organizational and care processes were associated with an altered pattern of sedative and analgesic drug prescription, a decrease in length of (noninvasive) respiratory support and length of stay in survivors, and decreases in resource use as measured by TISS-28 and mortality.Copyright © 2007 by Elsevier Inc. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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