The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit

• DOI: 10.1007/s00134-006-0309-0
• Publication Date: 2006-08-07T11:41:47Z
• Authors: Rosalind Elliott; Sharon McKinley; Leanne M. Aitken; Joan Hendrikz
• Keywords: Male; Time Factors; Mechanical Ventilation; Scoring System; 730302 Nursing; Injury; Clinical sciences; Nursing; Outcomes; Statistics, Nonparametric; 796; 730110 Respiratory system and diseases (incl. asthma); 03 medical and health sciences; C1; 0302 clinical medicine; Critical Care Medicine; Protocol; Humans; Hypnotics and Sedatives; Aged; Intensive Care; 730306 Evaluation of health outcomes; Clinical Practice Guideline; Length of Stay; Middle Aged; Respiration, Artificial; 3. Good health; 321103 Clinical Nursing - Secondary (Acute Care); Intensive Care Units; Impact; Treatment Outcome; Sedation; Critically-ill Patients; Female; Analgesia; New South Wales; Monte Carlo Method; Algorithms; 321009 Intensive Care

To examine the effect of an algorithm-based sedation guideline developed in a North American intensive care unit (ICU) on the duration of mechanical ventilation of patients in an Australian ICU.The intervention was tested in a pre-intervention, post-intervention comparative investigation in a 14-bed adult intensive care unit.Adult mechanically ventilated patients were selected consecutively (n=322). The pre-intervention and post-intervention groups were similar except for a higher number of patients with a neurological diagnosis in the pre-intervention group.An algorithm-based sedation guideline including a sedation scale was introduced using a multifaceted implementation strategy.The median duration of ventilation was 5.6 days in the post-intervention group, compared with 4.8 days for the pre-intervention group (P=0.99). The length of stay was 8.2 days in the post-intervention group versus 7.1 days in the pre-intervention group (P=0.04). There were no statistically significant differences for the other secondary outcomes, including the score on the Experience of Treatment in ICU 7 item questionnaire, number of tracheostomies and number of self-extubations. Records of compliance to recording the sedation score during both phases revealed that patients were slightly more deeply sedated when the guideline was used.The use of the algorithm-based sedation guideline did not reduce duration of mechanical ventilation in the setting of this study.