New ICU sedation protocols linked to fewer ventilator days
AT CHEST 2014
The number of ventilator days for the propofol-only group was between 5.6 days plus or minus another 5.8 days, nearly half of the total propofol/narcotic/benzodiazepine ventilator days which came to 10.5 days give or take another 8 days.
“It intuitively makes sense that the more drips the patients were on, the more they would be on a ventilator,” Dr. Campbell said.
However, for patients given benzodiazepines only, the number of ventilator days was 4.3, plus or minus 4.2 days. Dr. Campbell theorized this was attributable to there being a number of patients withdrawing from alcohol and so needing to rely on an infusion of the benzodiazepine to help them through the process.
Propofol-based regimens were associated with improved dose optimization compliance if patients were eligible (P less than .0001).
Patients given narcotic drips were more likely to meet their targeted RASS levels of –1 to +1, compared with either benzodiazepines or propofol, although propofol patient RASS targets were higher than those of the benzodiazepine group (43% for narcotics, 22% for benzodiazepines, and 37% for propofol, P less than .0001).
The study also found a relationship between failed extubation rates and sedative use. There were 953 patients extubated in all. Seven percent of the extubated patients who had received continuous sedation on the day of extubation had to be reintubated within 48 hours. A significant risk of reintubation was found for patients who’d been given propofol alone since nearly half of that cohort were among those reintubated (P = .01).
Although Dr. Campbell and his colleagues wrote in their study that this could have been due to either lower levels of sedation to begin with, and so being more likely to have earlier extubation, or that the respiratory physiology of this group was altered by the propofol.
“The most important take-away here was that being on any sedative within 24 hours of extubation meant you had a high rate of failing that extubation,” Dr. Campbell said.
The investigators were not able to determine precisely when the sedation was terminated in each patient, only that it had occurred within a 24-hour period prior to extubation.
Dr. Campbell also noted that since dexmedetomidine was not widely used at the site ICUs as an alternative sedative, a future inquiry into the reasons why not would be worthwhile. “I suspect it’s because it’s still one of the newer agents,” he said.
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