Sedation and weaning from mechanical ventilation: effects of process optimization outside a clinical trial
| Autor: | Raymond Friolet, Jukka Takala, Hans Ulrich Rothen, Szabina Lubszky, Anna Kolarova, Stephan M. Jakob |
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| Rok vydání: | 2006 |
| Předmět: |
Male
Time Factors medicine.drug_class Sedation medicine.medical_treatment Critical Care and Intensive Care Medicine Fentanyl law.invention Clinical Protocols law medicine Humans Hypnotics and Sedatives Hospital Mortality APACHE Aged Retrospective Studies Mechanical ventilation Analgesics business.industry Process Assessment Health Care Middle Aged Intensive care unit Organizational Innovation Intensive Care Units SAPS II Sedative Anesthesia Midazolam Female medicine.symptom business Propofol Ventilator Weaning Algorithms Switzerland medicine.drug |
| Zdroj: | Journal of critical care. 22(3) |
| ISSN: | 0883-9441 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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