A Prospective Evaluation of Sedative, Analgesic, Anti-Psychotic and Paralytic Practices in Canadian Mechanically Ventilated Adults.

Burry, Lisa; Perreault, Marc M.; Cook, Deborah J.; Wong, Zack C.F.; Rodrigues, H.; Hallett, David; Ethier, Cheryl; Markel, S; Quittnat, F; Ferguson, Niall D.; Mehta, Shilpa

doi:10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a5492

Cited by 5 publications

(6 citation statements)

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“…16,22,23 Reluctance to interrupt sedation infusions is expressed clearly in clinician surveys and practice audits. 11,12,24 Common clinical concerns include the potential for patient discomfort, respiratory distress, patient safety, and additional workload. 13,14,25,26 These reservations may reflect our unexpected findings of greater opioid and benzodiazepine doses, more bolus doses, and greater nurse workload among patients in the daily interruption group.…”

Section: Commentmentioning

confidence: 99%

Daily Sedation Interruption in Mechanically Ventilated Critically Ill Patients Cared for With a Sedation Protocol

Mehta¹

2012

JAMA

433

300

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Section: Commentmentioning

confidence: 99%

Daily Sedation Interruption in Mechanically Ventilated Critically Ill Patients Cared for With a Sedation Protocol

Mehta¹

2012

JAMA

433

300

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“…We conducted a secondary analysis of the I-CAN-SLEAP database. I-CAN-SLEAP was a prospective, observational study describing analgo-sedation, antipsychotic, and neuromuscular blocker administration and drug assessment or titration practices in 51 Canadian ICUs [ 23 ]. ICUs were recruited from all 10 provinces between 2008 and 2009, representing university-affiliated and community hospitals.…”

Section: Methodsmentioning

confidence: 99%

“…We conducted a secondary analysis of PR use in a large, heterogeneous sample of mechanically ventilated (MV) patients admitted to 51 Canadian ICUs [ 23 ]. Our objectives were to: (1) describe patterns of PR use in MV patients (prevalence, number of days of use, number of episodes of use); and (2) identify patient, treatment, and ICU/hospital characteristics associated with PR use and number of days of use.…”

Section: Introductionmentioning

confidence: 99%

Predictors of physical restraint use in Canadian intensive care units

et al. 2014

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IntroductionPhysical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use.MethodsWe conducted a secondary analysis of a prospective observational study of analgosedation, antipsychotic, neuromuscular blocker, and PR practices in 51 Canadian ICUs. Data were collected prospectively for all mechanically ventilated adults admitted during a two-week period. We tested for patient, treatment, and hospital characteristics that were associated with PR use and number of days of use, using logistic and Poisson regression respectively.ResultsPR was used on 374 out of 711 (53%) patients, for a mean number of 4.1 (standard deviation (SD) 4.0) days. Treatment characteristics associated with PR were higher daily benzodiazepine dose (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00 to 1.11), higher daily opioid dose (OR 1.04, 95% CI 1.01 to 1.06), antipsychotic drugs (OR 3.09, 95% CI 1.74 to 5.48), agitation (Sedation-Agitation Scale (SAS) >4) (OR 3.73, 95% CI 1.50 to 9.29), and sedation administration method (continuous and bolus versus bolus only) (OR 3.09, 95% CI 1.74 to 5.48). Hospital characteristics associated with PR indicated patients were less likely to be restrained in ICUs from university-affiliated hospitals (OR 0.32, 95% CI 0.17 to 0.61). Mainly treatment characteristics were associated with more days of PR, including: higher daily benzodiazepine dose (incidence rate ratio (IRR) 1.07, 95% CI 1.01 to 1.13), daily sedation interruption (IRR 3.44, 95% CI 1.48 to 8.10), antipsychotic drugs (IRR 15.67, 95% CI 6.62 to 37.12), SAS <3 (IRR 2.62, 95% CI 1.08 to 6.35), and any adverse event including accidental device removal (IRR 8.27, 95% CI 2.07 to 33.08). Patient characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, admission category, prior substance abuse, prior psychotropic medication, pre-existing psychiatric condition or dementia) were not associated with PR use or number of days used.ConclusionsPR was used in half of the patients in these 51 ICUs. Treatment characteristics predominantly predicted PR use, as opposed to patient or hospital/ICU characteristics. Use of sedative, analgesic, and antipsychotic drugs, agitation, heavy sedation, and occurrence of an adverse event predicted PR use or number of days used.

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“…[1][2][3] Currently, 2 classes of medications are commonly used for sedation: ␥-aminobutyric acid (GABA) agonists, such as midazolam, lorazepam, and propofol; and ␣ 2 -agonists, such as clonidine and dexmedetomidine. In Canada, midazolam and propofol are the most common sedatives, 4 whereas in the United States, midazolam, lorazepam, and propofol tend to be used most frequently. 5 GABA agonists generally cause prolonged sedation and are known to interact with other medications and to cause serious adverse events such as hypotension and respiratory depression.…”

Section: Résultatsmentioning

confidence: 99%

Economic Evaluation of Dexmedetomidine Relative to Midazolam for Sedation in the Intensive Care Unit

Lachaine

Beauchemin

2012

CJHP

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A Prospective Evaluation of Sedative, Analgesic, Anti-Psychotic and Paralytic Practices in Canadian Mechanically Ventilated Adults.

Cited by 5 publications

References 0 publications

Daily Sedation Interruption in Mechanically Ventilated Critically Ill Patients Cared for With a Sedation Protocol

Daily Sedation Interruption in Mechanically Ventilated Critically Ill Patients Cared for With a Sedation Protocol

Predictors of physical restraint use in Canadian intensive care units

Economic Evaluation of Dexmedetomidine Relative to Midazolam for Sedation in the Intensive Care Unit

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