ABSTRACT
A great part of the patients in an Intensive Care Unit (ICU) need sedo-analgesia (SA), specially in mechanic ventilation (MV). Our unit is a general ICU where a diversity of therapeuticschemes and farmacological presentations have been used, without standard practices. At a first stage we introduced SA recommendations, reinforcing its use. We conducted the present study to evaluate its effect in our clinical practice. Methodology: Indicators of adverse incidents were registered, associated to MV, mortality, permanence in MV,hospitalization in ICU, use of medicines and cost, the results were measured during the 3 months prior to beginning and the 3 months following implementation of the SA recommendations, which ruled the use of the association of midazolam (MZ) (Dormonid (R), Laboratorio Roche (R) and morphine; in cases of the renal insufficiency, hemo-dynamic instability or allergic reaction it was chosen to associate MZ and fentanyl, both associations in continuous infusion and with suspension of morning sedation. The sedation level had to be evaluated with ramsay scale. Neurological patients were excluded. It was considered "strict compliance" when the recommended combination of medicines were utilized, adjusted by sedation scale and with matinal suspension; "partial compliance" when these were utilized without complying with the scale adjustement or the matinal suspension. The results obtained were analyzed utilizing the Primer(R) statistical program. Results: Before the introduction of the recommendations we observed an average MV duration of 5,8 days (Range: 1-82), duration of ICU hospitalization of 9,8 days (Range: 1-101), a mortality of 28 per cent, one case of auto-extubation, with the use of one average dose of MZ of 10±1,8 mg/hr, with a montly use of MZ in the unit of 22,2 g., a montly expense in sedatives, analgesics and relaxants of US$3018. After its introduction we observed an average duration at MV of 4,5 days (Range: 1-41) (NS), duration of hospitalization at ICU of 5,0 days (Range: 1-45) (p=0,001), a mortality of 22 per cent (NS), one case of auto-extubation, with an average dose of MZ of 4,2 g. (p=0,001), a montly expense in sedatives, analgesics and relaxants of US$809 (p=0,0001). Average compliance with the recommendations was 68 per cent (46 per cent partial, 22 per cent strict).