New ICU sedation protocols linked to fewer ventilator days

Key clinical point: Physicians are preferentially avoiding benzodiazepines in the ICU with better results overall.

Major finding: ICU patients sedated with propofol-based regimens were more likely to undergo daily dose optimization, maintain target RASS, compared with benzodiazepines, and be intubated fewer days.

Data source: Retrospective study of 988 intubated patients and 6,359 ventilation days over 10 months at a single tertiary, academic medical center.

Disclosures: Dr. Campbell said neither he nor his coauthors had relevant disclosures.




AUSTIN, TEX. – Patients given propofol-based sedation in the intensive care unit were more likely to have daily dose optimization, stay at their target Richmond Agitation Sedation Scale rate, and be intubated for fewer days, compared with patients given benzodiazepine-based regimens, a retrospective study has shown. Being on propofol at the time of extubation, however, was associated with a significantly higher risk of being reintubated.

In 2013, the American College of Critical Care Medicine updated its guidelines for sedation in the ICU. The changes reflected what Dr. Steven J. Campbell, a presenter at this year’s annual meeting of the American College of Chest Physicians, said was the new paradigm in ICU sedation – namely, to use the least amount of sedation in patients and for the shortest amount of time possible. “We’ve also seen a shift away from benzodiazepines in recent years, and that when patients are given them, they stay in ICUs longer and have longer ventilation times,” Dr. Campbell said. The updated guidelines also suggest not relying on benzodiazepines as a first-line sedative.

To investigate how the updated sedation protocols have impacted the multiple ICUs at Ohio State University’s tertiary medical center, where Dr. Campbell is a third-year medical resident, and to assess the relationship of the changes with reintubation risk, Dr. Campbell and his colleagues retrospectively analyzed data on 988 intubated patients and 6,359 ventilator days recorded at the medical center during a 10-month period in 2013, after the new protocols were in place.

Considering either single sedation drips or combined sedation drips in the 988 unique intubations, about 69% of patients received at least 1 day of propofol, and roughly a third were given at least 1 day of a narcotic.

For 373 patients, the most commonly used drip was propofol only. Propofol combined with a narcotic was used in 141 patients, whereas the a combination of the two with a benzodiazepine was used in 140 patients.

A quarter of all intubated patients received at least 1 day of a continuous benzodiazepine drip, although only 7% of these received this sedation regimen as a first-line agent. Data were not presented on what previous benzodiazepine sedation rates were at the center before the protocol change.

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