Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica

Background: 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...

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Autores principales:	Tobar A,Eduardo, Lanas M,Alejandra, Pino P,Sandra, Aspée L,Paulina, Rivas V,Sandra, Prat R,Daniela, Asenjo B,Rosmi, Castro O,José
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2008
Materias:	Hypnotics and sedatives Nurse practitioners Respiration, artificial
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000600004
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spelling	oai:scielo:S0034-988720080006000042008-08-27Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánicaTobar A,EduardoLanas M,AlejandraPino P,SandraAspée L,PaulinaRivas V,SandraPrat R,DanielaAsenjo B,RosmiCastro O,José Hypnotics and sedatives Nurse practitioners Respiration, artificial Background: 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. Aun: 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: Inclusión criteria was the need of MV more than 48 h. The exclusión 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 patientsinfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.136 n.6 20082008-06-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000600004es10.4067/S0034-98872008000600004
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Hypnotics and sedatives Nurse practitioners Respiration, artificial
spellingShingle	Hypnotics and sedatives Nurse practitioners Respiration, artificial Tobar A,Eduardo Lanas M,Alejandra Pino P,Sandra Aspée L,Paulina Rivas V,Sandra Prat R,Daniela Asenjo B,Rosmi Castro O,José Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica
description	Background: 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. Aun: 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: Inclusión criteria was the need of MV more than 48 h. The exclusión 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
author	Tobar A,Eduardo Lanas M,Alejandra Pino P,Sandra Aspée L,Paulina Rivas V,Sandra Prat R,Daniela Asenjo B,Rosmi Castro O,José
author_facet	Tobar A,Eduardo Lanas M,Alejandra Pino P,Sandra Aspée L,Paulina Rivas V,Sandra Prat R,Daniela Asenjo B,Rosmi Castro O,José
author_sort	Tobar A,Eduardo
title	Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica
title_short	Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica
title_full	Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica
title_fullStr	Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica
title_full_unstemmed	Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica
title_sort	sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica
publisher	Sociedad Médica de Santiago
publishDate	2008
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000600004
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Sedación guiada por protocolo versus manejo convencional en pacientes críticos en ventilación mecánica

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