Does an Evidence-Based Sedation Protocol Improve Practice and Patient Outcomes in Critical Care?

2.50
Hdl Handle:
http://hdl.handle.net/10755/154064
Type:
Presentation
Title:
Does an Evidence-Based Sedation Protocol Improve Practice and Patient Outcomes in Critical Care?
Abstract:
Does an Evidence-Based Sedation Protocol Improve Practice and Patient Outcomes in Critical Care?
Conference Sponsor:Sigma Theta Tau International
Conference Year:2008
Author:Bucknall, Tracey K., RN, ICUCert, BN, GradDipAdvNurs, PhD
P.I. Institution Name:Deakin University
Title:Professor
Co-Authors:Elizabeth Manias, RN, MPharm, PhD; Jeffery Presneill, MBBS, PhD, FRACP, FJFICM
[Research Paper or Poster Presentation] Minimization of sedation in critical care patients has recently received widespread support. Professional organizations internationally have published sedation management guidelines for critically ill patients to improve the use of research in practice, decrease practice variability and shorten mechanical ventilation duration. Innovations in practice have included the introduction of decision making protocols, daily sedation interruptions and new drugs and monitoring technologies. The aim of this study was to compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care setting. A randomized, controlled trial design was used to study 312 mechanically ventilated adult patients in a general critical care unit at an Australian metropolitan teaching hospital. Patients were randomly assigned to receive protocol directed sedation management developed from evidence based guidelines (n=153) or usual clinical practice (n=159). The median (95% CI) duration of ventilation was 58 hrs (44û78 hrs) for patients in the non-protocol group and 79 hrs (56û93) for those patients in the protocol group (p=0.20). Results were not significant for length of stay in critical care or hospital, the frequency of tracheostomies, and unplanned extubations. A Cox proportional hazards model estimated that protocol directed sedation management was associated with a 22% decrease (95% CI: 40% decrease to 2% increase, p=0.07) in the occurrence of successful weaning from mechanical ventilation. Few randomized controlled trials have evaluated the effectiveness of protocol-directed sedation outside of North America. This study highlights the lack of transferability between different settings and different models of care. Qualified, high intensity nursing in the Australian critical care setting facilitates rapid, responsive decisions for sedation management and an increased success rate for weaning from mechanical ventilation.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDoes an Evidence-Based Sedation Protocol Improve Practice and Patient Outcomes in Critical Care?en_GB
dc.identifier.urihttp://hdl.handle.net/10755/154064-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Does an Evidence-Based Sedation Protocol Improve Practice and Patient Outcomes in Critical Care?</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2008</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Bucknall, Tracey K., RN, ICUCert, BN, GradDipAdvNurs, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Deakin University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">tracey.bucknall@deakin.edu.au</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Elizabeth Manias, RN, MPharm, PhD; Jeffery Presneill, MBBS, PhD, FRACP, FJFICM</td></tr><tr><td colspan="2" class="item-abstract">[Research Paper or Poster Presentation] Minimization of sedation in critical care patients has recently received widespread support. Professional organizations internationally have published sedation management guidelines for critically ill patients to improve the use of research in practice, decrease practice variability and shorten mechanical ventilation duration. Innovations in practice have included the introduction of decision making protocols, daily sedation interruptions and new drugs and monitoring technologies. The aim of this study was to compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care setting. A randomized, controlled trial design was used to study 312 mechanically ventilated adult patients in a general critical care unit at an Australian metropolitan teaching hospital. Patients were randomly assigned to receive protocol directed sedation management developed from evidence based guidelines (n=153) or usual clinical practice (n=159). The median (95% CI) duration of ventilation was 58 hrs (44&ucirc;78 hrs) for patients in the non-protocol group and 79 hrs (56&ucirc;93) for those patients in the protocol group (p=0.20). Results were not significant for length of stay in critical care or hospital, the frequency of tracheostomies, and unplanned extubations. A Cox proportional hazards model estimated that protocol directed sedation management was associated with a 22% decrease (95% CI: 40% decrease to 2% increase, p=0.07) in the occurrence of successful weaning from mechanical ventilation. Few randomized controlled trials have evaluated the effectiveness of protocol-directed sedation outside of North America. This study highlights the lack of transferability between different settings and different models of care. Qualified, high intensity nursing in the Australian critical care setting facilitates rapid, responsive decisions for sedation management and an increased success rate for weaning from mechanical ventilation.</td></tr></table>en_GB
dc.date.available2011-10-26T12:43:02Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T12:43:02Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.