Sedation management is an integral part of managing ventilated patients. A standardized sedation practice to reduce intensive care unit (ICU) length of stay (LOS) through implementation of a protocol was the intention of the study.
Evidence-based sedation guidelines for ventilated trauma patients were developed with input from physicians, nursing and pharmacy. The staff was inserviced and the protocol implemented in September 2003. The protocol promoted propofol for short-term sedation (less than 48 hours) and midazolam for long-term sedation (greater than 48 hours). Medication titration to a Modified Ramsey Scale of 3, daily awakenings and dose reductions were included in the protocol. The results were retrospectively examined with a prospective application of the protocol. A historic control group was used from the months prior to implementation of the protocol. Two six-month retrospective reviews of mechanically ventilated patients, baseline (Jan-June 2003) and post-protocol (Jan-June 2004), were performed.
A total of 39 patients were evaluated (baseline n = 14, post-protocol n = 25). The patients were predominately male (80% and 68%) and the average age (32.8 years vs. 37.4 years) and Injury Severity Scores (20.5 vs. 26.4) were not significantly different between groups. The amount of time on propofol was lower in the protocol group (24.1 vs. 35.3 hours). The mean ICU LOS in the protocol group was lower than the baseline group (5.2 days vs. 7.1 days). Overall LOS was lower in the protocol group than baseline (7.96 days vs. 11.14 days). Preliminary data is presented.
Utilization of a sedation protocol that includes proper selection of pharmacologic agents, sedation goals, daily awakenings and daily dose reductions resulted in a trend toward decreased ICU LOS and overall LOS. More data is needed to show significance.
Implementation of a sedation protocol may be an effective means to reduce the number of ventilator days and subsequent ICU LOS.
Rajesh Gandhi, None.