Predictors for daily interruption of sedation therapy by nurses: A prospective, multicenter study
Department of Pharmacy, Tufts Medical Center, Boston, MA 02120, USA. Journal of critical care
(Impact Factor: 2).
05/2010; 25(4):660.e1-7. DOI: 10.1016/j.jcrc.2010.03.007
The aim of the study was to identify the nurse and patient-related factors predicting daily interruption of sedation (DIS) performance by nurses in the intensive care unit (ICU).
Nurses, caring for a mechanically ventilated patient receiving 24 hours or more of a continuously infused sedative, were interviewed at the bedside to determine their willingness to perform DIS on this patient and to determine the influence of 20 nurse- and 47 patient-related factors on DIS completion.
The 57 (44%) of 130 of nurses willing to perform DIS had performed DIS at least once in the past (P < .0001) and were not targeting deep sedation (ie, Sedation Agitation Scale [SAS] ≤ 2 [P = .03]). The DIS performance was less likely with use of higher-dose continuous midazolam (P = .006), a fraction of inspired oxygen (Fio(2)) greater than 50% (P = .03), or positive end-expiratory pressure greater than 5 mm Hg (P = .006) and in patients either deeply sedated (SAS ≤ 2) (P = .05) or agitated (SAS ≥ 5) in the past 24 hours (P = .003). Prior DIS experience (odds ratio [OR], 2.54; P = .004), hours of sedation-related continuing education (OR, 1.13; P = .02), and a target of deep sedation (OR, 0.49; P = .02) were independent nurse-related factors for DIS performance. Nurse's willingness to conduct DIS ranged from 45% to 80% based on the interaction between patient sex, current Fio(2), and agitation in past 24 hours.
Educational strategies and institutional protocols focused on improving use of DIS need to consider the various nurse- and patient-related factors that affect DIS performance by nurses in the ICU.
Available from: Louise Rose
- "For patients assigned to the DI group, respondents were asked the additional question " I was concerned for my patient during DI due to the risk of… " and were provided with 6 categorical options as well as the opportunity for a textual response . We included this question to assess perceived safety concerns regarding DI that were raised by clinicians in previous studies     "
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ABSTRACT: Within a multicenter randomized trial comparing protocolized sedation with protocolized sedation plus daily interruption (DI), we sought perspectives of intensive care unit (ICU) clinicians regarding each strategy.
At 5 ICUs, we administered a questionnaire daily to nurses and physicians, asking whether they liked using the assigned strategy, reasons for their responses, and concerns regarding DI.
A total of 301 questionnaires were completed, for 31 patients (15 protocol only and 16 DI); 117 (59 physicians and 58 nurses) were the first questionnaire completed by that health care provider for that patient and were included in analyses. Most respondents liked using the assigned strategy (81% protocol only and 81% DI); more physicians than nurses liked DI (100% vs 61%; P < .001). Most common reasons for liking the assigned sedation strategy were better neurologic assessment (70% DI), ease of use (58% protocol only), and improved patient outcomes (51% protocol only and 44% DI). Only 19% of clinicians disliked the assigned sedation strategy (equal numbers for protocol only and DI). Respondents' concerns during DI were respiratory compromise (61%), pain (48%), agitation (45%), and device removal (26%). More questionnaires from nurses than physicians expressed concerns about DI.
Most respondents liked both sedation strategies. Nurses and physicians had different preferences and rationales for liking or disliking each strategy.
Copyright © 2014 Elsevier Inc. All rights reserved.
Journal of Critical Care 10/2014; 30(2). DOI:10.1016/j.jcrc.2014.10.021 · 2.00 Impact Factor
- "The aim of lighter sedation is to provide a level of comfort at which the patient can tolerate the interventions required. 'Sedation breaks', 'sedation holds' or 'daily interruption of sedation' (Roberts et al 2010) are necessary to assess sedation score and to ensure patients are not over sedated; these breaks from sedation are also associated with earlier weaning from ventilator support (Kress et al 2000). However, the use of light sedation may lead to increased psychological problems (Kress et al 2000, Samuelson et al 2003). "
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ABSTRACT: The use of patient diaries in critical care in the UK is increasing, but there is little evidence-based research available to support this. The National Institute for Health and Clinical Excellence (NICE) has recommended that services should be developed to meet the psychological care needs of patients following critical illness. One response to this has been the introduction of patient diaries. To gain insight into the use of patient diaries in critical care, a literature review was conducted. This article provides an overview of the literature and suggests how it can inform clinical practice in relation to diary use in critical care and beyond.
Nursing standard: official newspaper of the Royal College of Nursing 11/2011; 26(11):35-43. DOI:10.7748/ns2011.11.26.11.35.c8822
Available from: Matthew Newman
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ABSTRACT: To measure the impact of a national propofol shortage on the duration of mechanical ventilation.
Three, noncardiac surgery, adult intensive care units at a 320-bed academic medical center.
Consecutive patients requiring mechanical ventilation ≥48 hrs, administered a continuously infused sedative ≥24 hrs, extubated, and successfully discharged from the intensive care unit were compared between before (December 1, 2008 to May 31, 2009) and after (December 1, 2009, to May 31, 2010) a propofol shortage.
Sedation drug use and common factors affecting time on mechanical ventilation were collected and if found either to differ significantly (p ≤ .10) between the two groups or to have an unadjusted significant association (p ≤ .10) with time on mechanical ventilation were included in a multivariable model. The unadjusted analyses revealed that the median (interquartile range) duration of mechanical ventilation increased from 6.7 (9.8; n = 153) to 9.6 (9.5; n = 128) days (p = .02). Fewer after-group patients received ≥24 hrs of continuously infused propofol (94% vs. 15%, p < .0001); more received ≥24 hrs of continuously infused lorazepam (7% vs. 15%, p = .037) and midazolam (30% vs. 81%, p < .0001). Compared with the before group, the after group was younger, had a higher admission Acute Physiology and Chronic Health Evaluation II score, was more likely to be admitted by a surgical service, have acute alcohol withdrawal, and be managed with pressure-controlled ventilation as the primary mode of mechanical ventilation. Of these five factors, only the Acute Physiology and Chronic Health Evaluation II score, admission service, and use of a pressure-controlled ventilation affected duration of mechanical ventilation across both groups. Although a regression model revealed that Acute Physiology and Chronic Health Evaluation II score (p < .0001), admission by a medical service (p = .009), and use of pressure-controlled ventilation (p = .02) each affected duration of mechanical ventilation in both groups, inclusion in either the before- or after-propofol shortage groups (i.e., high vs. low use of propofol) did not affect duration of mechanical ventilation (p = .35).
An 84% decrease in propofol use in the adult intensive care units at our academic institution as a result of a national shortage did not affect duration of mechanical ventilation.
Critical care medicine 09/2011; 40(2):406-11. DOI:10.1097/CCM.0b013e31822f0af5 · 6.31 Impact Factor
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