| dc.description.abstract | 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. Aim: 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 and
methods: Inclusion criteria was the need of MV more than 48 h. The exclusion 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% and 32%, 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 | |
