Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica / Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation
Rev. méd. Chile
;
136(6): 711-718, jun. 2008. tab
Article
in Spanish
| LILACS
| ID: lil-490755
ABSTRACT
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 protocols, however this is seldom done in clinical practice. Aun 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 andmethods:
Inclusión criteria was the need of MV more than 48 h. The exclusión criteria were acute neurological diseases, hepatic cirrhosis, chronic renal failure and limitation of therapeutic efforts. Midazolam and fentanyl 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 adjust the sedative 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 percent and 32 percent, respectively p =0.001). No differences in the proportion of patients with inadequate 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 (0.03-0.08) mg/kg/h respectively, p =0.005).Conclusions:
The implementation of sedation protocol applied by nurses improved the quality of sedation and reduced the doses of Midazolam in mechanically ventilated patients.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Respiration, Artificial
/
Conscious Sedation
/
Critical Illness
/
Analgesia
/
Analgesics, Opioid
/
Hypnotics and Sedatives
Type of study:
Controlled clinical trial
/
Practice guideline
Limits:
Aged
/
Humans
Language:
Spanish
Journal:
Rev. méd. Chile
Journal subject:
Medicine
Year:
2008
Type:
Article
Affiliation country:
Chile
Institution/Affiliation country:
Universidad de Chile/CL
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