Daily Interruption of Sedation versus Continuous Sedation and Length of Mechanical Ventilation

2.50
Hdl Handle:
http://hdl.handle.net/10755/602767
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Title:
Daily Interruption of Sedation versus Continuous Sedation and Length of Mechanical Ventilation
Author(s):
Weise, Crystal Nicole
Lead Author STTI Affiliation:
Eta Eta
Author Details:
Crystal Nicole Weise, RN, cmeininger89@hotmail.com
Abstract:
Session presented on Monday, November 9, 2015 and Tuesday, November 10, 2015: Hundreds of thousands of critical care patients are intubated every year. Many of these patients are sedated for comfort. However, continuous moderate to deep sedation can lead to increased ventilator days and other morbitities, including delirium. Every intensive care unit uses a variety of sedation practices. Furthermore, there are barriers to the healthcare team using daily sedation interruptions. These include the concern that the patient will self extubate and that it will worsen the patient’s respiratory status. This leads to practitioners not implementing the practice. Objective: The objective of the systematic review is to determine if conducting daily sedation interruptions for ventilated adult intensive care patients will decrease the length of mechanical ventilation. The secondary objective is to determine if the sedation interruptions are safe and feasible. Method: A literature search was conducted using CINHAL, Ovid/Medline and Embase databases. Eleven primary studies and one systematic review was kept after using key words and limiting the articles to articles no older than 2008, English and adult patients. These articles were critiqued based on their methods, number of participants and results. Then they were assigned a SORT level of evidence. There were seven level 2 articles and 3 level 1 articles. The main limitation of the studies were the inability of the studies to be blinded. Results: The data provided by the studies were inconclusive. However, based on the findings of the studies it is safe and feasible to conduct the daily sedation interruptions in mechanically ventilated patients in the intensive care unit. Many barriers still exist, including the fear of self extubation, patient agitation and worsened respiratory status. Recommendation: It is recommended that in patients that have been intubated for more than 48 hours that a sedation interruption and when the patient’s RASS is zero a spontaneous breathing trial should be conducted. If the patient passes the spontaneous breathing trial the patient can be extubated per physician order. If the patient becomes agitated or has worsening respiratory status during the sedation interruption, the patient fails and will be put back on the sedative medication at half the current rate. This process will be conducted daily as long as the patient is intubated and hemodynamically stable. Starting this practice in the intensive care unit will better patient outcomes, decrease ventilator days and decrease health care costs. Change Model: To implement this change the Kotter and Cohen change model is to be used. The key stake holders that need to be involved in the process are the mechanically ventilated patients and their families, the nurse manager, nursing and physician staff. The leaders of change are the nurse manager, lead intensive care attending and senior nursing staff. When the change is implemented it will be evaluated by using staff questionnaires and tracking individual patient’s outcomes, any adverse events and the average number of mechanical ventilation days before and after the intervention.
Keywords:
Mechanical ventilation; Adult Critical Care Patients; Sedation
Repository Posting Date:
21-Mar-2016
Date of Publication:
21-Mar-2016
Other Identifiers:
CONV15EB2.38
Conference Date:
2015
Conference Name:
43rd Biennial Convention
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Las Vegas, Nevada, USA
Description:
43rd Biennial Convention 2015 Theme: Serve Locally, Transform Regionally, Lead Globally.`

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.titleDaily Interruption of Sedation versus Continuous Sedation and Length of Mechanical Ventilationen
dc.contributor.authorWeise, Crystal Nicoleen
dc.contributor.departmentEta Etaen
dc.author.detailsCrystal Nicole Weise, RN, cmeininger89@hotmail.comen
dc.identifier.urihttp://hdl.handle.net/10755/602767en
dc.description.abstractSession presented on Monday, November 9, 2015 and Tuesday, November 10, 2015: Hundreds of thousands of critical care patients are intubated every year. Many of these patients are sedated for comfort. However, continuous moderate to deep sedation can lead to increased ventilator days and other morbitities, including delirium. Every intensive care unit uses a variety of sedation practices. Furthermore, there are barriers to the healthcare team using daily sedation interruptions. These include the concern that the patient will self extubate and that it will worsen the patient’s respiratory status. This leads to practitioners not implementing the practice. Objective: The objective of the systematic review is to determine if conducting daily sedation interruptions for ventilated adult intensive care patients will decrease the length of mechanical ventilation. The secondary objective is to determine if the sedation interruptions are safe and feasible. Method: A literature search was conducted using CINHAL, Ovid/Medline and Embase databases. Eleven primary studies and one systematic review was kept after using key words and limiting the articles to articles no older than 2008, English and adult patients. These articles were critiqued based on their methods, number of participants and results. Then they were assigned a SORT level of evidence. There were seven level 2 articles and 3 level 1 articles. The main limitation of the studies were the inability of the studies to be blinded. Results: The data provided by the studies were inconclusive. However, based on the findings of the studies it is safe and feasible to conduct the daily sedation interruptions in mechanically ventilated patients in the intensive care unit. Many barriers still exist, including the fear of self extubation, patient agitation and worsened respiratory status. Recommendation: It is recommended that in patients that have been intubated for more than 48 hours that a sedation interruption and when the patient’s RASS is zero a spontaneous breathing trial should be conducted. If the patient passes the spontaneous breathing trial the patient can be extubated per physician order. If the patient becomes agitated or has worsening respiratory status during the sedation interruption, the patient fails and will be put back on the sedative medication at half the current rate. This process will be conducted daily as long as the patient is intubated and hemodynamically stable. Starting this practice in the intensive care unit will better patient outcomes, decrease ventilator days and decrease health care costs. Change Model: To implement this change the Kotter and Cohen change model is to be used. The key stake holders that need to be involved in the process are the mechanically ventilated patients and their families, the nurse manager, nursing and physician staff. The leaders of change are the nurse manager, lead intensive care attending and senior nursing staff. When the change is implemented it will be evaluated by using staff questionnaires and tracking individual patient’s outcomes, any adverse events and the average number of mechanical ventilation days before and after the intervention.en
dc.subjectMechanical ventilationen
dc.subjectAdult Critical Care Patientsen
dc.subjectSedationen
dc.date.available2016-03-21T16:36:18Zen
dc.date.issued2016-03-21en
dc.date.accessioned2016-03-21T16:36:18Zen
dc.conference.date2015en
dc.conference.name43rd Biennial Conventionen
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen
dc.conference.locationLas Vegas, Nevada, USAen
dc.description43rd Biennial Convention 2015 Theme: Serve Locally, Transform Regionally, Lead Globally.`en
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