Achieving sedation goals of physiologic stability and comfort at various sedation levels in the mechanically ventilated

2.50
Hdl Handle:
http://hdl.handle.net/10755/156989
Category:
Abstract
Type:
Presentation
Title:
Achieving sedation goals of physiologic stability and comfort at various sedation levels in the mechanically ventilated
Author(s):
Grap, Mary Jo; Pickler, Rita; Ketchum, Jessica; Munro, Cindy; Hamilton, Virginia; Wetzel, Paul; Sessler, Curtis; Areif, Nyimas
Author Details:
Mary Jo Grap, PhD, RN, FAAN, Virginia Commonwealth University, Richmond, Virginia, USA, email: mjgrap@vcu.edu; Rita Pickler; Jessica Ketchum; Cindy Munro; Virginia Hamilton; Paul Wetzel; Curtis Sessler; Nyimas Areif
Abstract:
POSTER PURPOSE: To examine effects of various levels of sedation on specified sedation outcomes of physiological stability and comfort. BACKGROUND/SIGNIFICANCE:A majority (85%) of patients in the intensive care unit (ICU) receive sedatives to ameliorate the pain and agitation that occur with mechanical ventilation (MV). Excessive levels of sedation increase the duration of MV and ventilator-associated pneumonia, whereas inadequate sedation increases risk for unplanned extubation and hemodynamic instability. Validated sedation scales are used to assess levels of sedation, but how successfully the goals of physiological stability and comfort are met at these various levels is unknown. METHOD: A total of 110 ICU patients receiving MV were continuously monitored for 24 hours, with data recorded every 12 seconds. Sedation levels were measured by using the SEDLine (processed electroencephalogram), and physiological stability was measured by heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2). Comfort was evaluated by using arm and leg actigraphy to measure patientsÆ movement. For this analysis, 210 total hours of data (1.9 hours per subject) were downloaded and analyzed for the percentage of time spent outside of clinically normal ranges for HR (60û100/min), RR (12û20/min), SpO2 (>95%), and actigraphy (based on validated data for each sedation state). Sedation level was categorized via the Patient State Index (PSI) as deep (PSI, <60), mild (PSI, 60û80), or alert (PSI, >80). RESULTS: Patients were 57% male, had a mean age 52.6 years, and were from the cardiac surgery ICU (13%), medical respiratory ICU (52%), and surgical trauma ICU (35%). They spent a mean of 45% of the time in deep sedation, 35% in mild sedation, and 20% alert. The probability of normal HR was greatest during deep sedation (0.74), followed by mild sedation (0.60) and alert status (0.51). The probability of normal RR was greatest during the deep sedation state (0.55) and was lower in mild (0.45) and alert states (0.46). The probability of normal findings on actigraphy was high during all sedation states (>0.99), as was SpO2 (0.96û0.98), but highest during the deep sedation state. CONCLUSIONS: Although physiological stability goals of HR, RR, and SpO2 within normal range were primarily achieved in deep levels of sedation, lighter levels of sedation met these goals about half of the time. Because the goals of sedation were met at most 74% of the time, and were lower during mild sedation and alert states, current methods of evaluating sedation may not be adequate to assess all domains of sedation efficacy.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleAchieving sedation goals of physiologic stability and comfort at various sedation levels in the mechanically ventilateden_GB
dc.contributor.authorGrap, Mary Joen_GB
dc.contributor.authorPickler, Ritaen_GB
dc.contributor.authorKetchum, Jessicaen_GB
dc.contributor.authorMunro, Cindyen_GB
dc.contributor.authorHamilton, Virginiaen_GB
dc.contributor.authorWetzel, Paulen_GB
dc.contributor.authorSessler, Curtisen_GB
dc.contributor.authorAreif, Nyimasen_GB
dc.author.detailsMary Jo Grap, PhD, RN, FAAN, Virginia Commonwealth University, Richmond, Virginia, USA, email: mjgrap@vcu.edu; Rita Pickler; Jessica Ketchum; Cindy Munro; Virginia Hamilton; Paul Wetzel; Curtis Sessler; Nyimas Areifen_GB
dc.identifier.urihttp://hdl.handle.net/10755/156989-
dc.description.abstractPOSTER PURPOSE: To examine effects of various levels of sedation on specified sedation outcomes of physiological stability and comfort. BACKGROUND/SIGNIFICANCE:A majority (85%) of patients in the intensive care unit (ICU) receive sedatives to ameliorate the pain and agitation that occur with mechanical ventilation (MV). Excessive levels of sedation increase the duration of MV and ventilator-associated pneumonia, whereas inadequate sedation increases risk for unplanned extubation and hemodynamic instability. Validated sedation scales are used to assess levels of sedation, but how successfully the goals of physiological stability and comfort are met at these various levels is unknown. METHOD: A total of 110 ICU patients receiving MV were continuously monitored for 24 hours, with data recorded every 12 seconds. Sedation levels were measured by using the SEDLine (processed electroencephalogram), and physiological stability was measured by heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2). Comfort was evaluated by using arm and leg actigraphy to measure patients&AElig; movement. For this analysis, 210 total hours of data (1.9 hours per subject) were downloaded and analyzed for the percentage of time spent outside of clinically normal ranges for HR (60&ucirc;100/min), RR (12&ucirc;20/min), SpO2 (>95%), and actigraphy (based on validated data for each sedation state). Sedation level was categorized via the Patient State Index (PSI) as deep (PSI, <60), mild (PSI, 60&ucirc;80), or alert (PSI, >80). RESULTS: Patients were 57% male, had a mean age 52.6 years, and were from the cardiac surgery ICU (13%), medical respiratory ICU (52%), and surgical trauma ICU (35%). They spent a mean of 45% of the time in deep sedation, 35% in mild sedation, and 20% alert. The probability of normal HR was greatest during deep sedation (0.74), followed by mild sedation (0.60) and alert status (0.51). The probability of normal RR was greatest during the deep sedation state (0.55) and was lower in mild (0.45) and alert states (0.46). The probability of normal findings on actigraphy was high during all sedation states (>0.99), as was SpO2 (0.96&ucirc;0.98), but highest during the deep sedation state. CONCLUSIONS: Although physiological stability goals of HR, RR, and SpO2 within normal range were primarily achieved in deep levels of sedation, lighter levels of sedation met these goals about half of the time. Because the goals of sedation were met at most 74% of the time, and were lower during mild sedation and alert states, current methods of evaluating sedation may not be adequate to assess all domains of sedation efficacy.en_GB
dc.date.available2011-10-26T19:19:22Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:19:22Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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