Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients*

Schweickert, William D.; Gehlbach, Brian K.; Pohlman, Anne S.; Hall, Jesse B.; Kress, John P.

doi:10.1097/01.ccm.0000127263.54807.79

Cited by 357 publications

(183 citation statements)

References 31 publications

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“…Studies by Brook et al and Kress et al have demonstrated that protocols for sedative and analgesic administration with the goal of minimizing constant infusions led to reduced DOMV (22,113). Furthermore, daily interruption of sedation results in a reduced incidence of intensive care unit complications, in which VAP was included (127,180). Weaning protocols have also resulted in reduced DOMV, whether respiratory therapist initiated or not (59,67).…”

Section: Preventionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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SUMMARY While critically ill patients experience a life-threatening illness, they commonly contract ventilator-associated pneumonia. This nosocomial infection increases morbidity and likely mortality as well as the cost of health care. This article reviews the literature with regard to diagnosis, treatment, and prevention. It provides conclusions that can be implemented in practice as well as an algorithm for the bedside clinician and also focuses on the controversies with regard to diagnostic tools and approaches, treatment plans, and prevention strategies.

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Section: Preventionmentioning

confidence: 99%

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

2006

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“…[28] Use of lighter sedation may reduce the rate of ICU-acquired neuromuscular weakness. [29][30] In this study, patients in the two groups were given daily interruption of sedation or no sedatives.…”

Section: Discussionmentioning

confidence: 99%

Effects of early rehabilitation therapy on patients with mechanical ventilation

Dong

Sun

et al. 2014

World Journal of Emergency Medicine

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BACKGROUND: For patients in intensive care unit (ICU), mechanical ventilation is an effective treatment to survive from acute illness and improve survival rates. However, long periods of bed rest and restricted physical activity can result in side effects. This study aimed to investigate the feasibility of early rehabilitation therapy in patients with mechanical ventilation. METHODS:A randomized controlled trial was carried out. Sixty patients, with tracheal intubation or tracheostomy more than 48 hours and less than 72 hours, were admitted to the ICU of the Affi liated Hospital of Medical College, Qingdao University, from May 2010 to May 2012. These patients were randomly divided into a rehabilitation group and a control group. In the rehabilitation group, rehabilitation therapy was performed twice daily, and the training time and intensity were adjusted according to the condition of the patients. Early rehabilitation therapy included heading up actively, transferring from the supine position to sitting position, sitting at the edge of the bed, sitting in chair, transferring from sitting to standing, and ambulating bedside. The patient's body mass index, days to fi rst out of bed, duration of mechanical ventilation, length of ICU stay, APACHE II score, highest FiO 2 , lowest PaO 2 /FiO 2 and hospital mortality of patients were all compared between the rehabilitation group and the control group. The differences between the two groups were compared using Student's t test. RESULTS:There was no signifi cant difference in body mass index, APACHE II score, highest CONCLUSION: Early rehabilitation therapy was feasible and effective in improving the outcomes of patients with mechanical ventilation.

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“…[18,19] When compared to the current literature, we observed that the EPs in Turkey are using sedative and paralyzing drugs less frequently. This result suggests that there may be a deficiency in the knowledge and experience in MVM in Turkey.…”

Section: Discussionmentioning

confidence: 78%

Mechanical Ventilation Practices of Turkish Emergency Physicians: A National Survey

Düzenli¹,

Sever²,

Aksay³

2013

Tr J Emerg Med

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SUMMARY ObjectivesThe objective of this study is to ascertain the mechanical ventilation management skill perception levels of emergency physicians in Turkey as well as to determine the infrastructural condition of ED in Turkey with respect to mechanical ventilation. MethodsWe distributed a survey to all emergency physicians in Turkey. The contents of the survey consisted of 4 main areas that paralleled the objectives of the study. (1) Socio-demographic characteristics, (2) the situation of the personnel and the technical infra-structure in the ED (3) the Emergency Medicine Training Program (EMTP) and post graduate training, and (4) suggested solutions. Each physician's perception level was evaluated with a 10 cm Visual Analogue Scale. Results Four-hundred emergency physicians participated in the study (response rate = 70.5%). The means of the emergency physicians' perceptions as to whether or not the personnel and technical infrastructure for mechanical ventilation management are adequate in the institutions in which they work were 3.2±2.4 cm and 3.4±2.4 cm, respectively. It was determined that 75.5% of the participants did not receive any education regarding mechanical ventilation management during their emergency medicine education program. The means of the physicians' perception levels regarding the number of times they practiced mechanical ventilation during their emergency medicine education program was 4.6±2.2 cm, and the means of their perception levels regarding their own knowledge and skills on mechanical ventilation management was 5.4±2 cm. It was determined that during mechanical ventilation, 29.5% of emergency physicians had not used any sedative agents, and 30.2% of them had not used any paralyzing agents. It was also determined that midazolam (30.7%) was used most frequently for sedation, fentanyl (50.7%) was used most often for analgesia, and vecuronium (27%) was used most frequently as a neuromuscular blocker. The most frequently reported problem regarding formal mechanical ventilation management set forth by the participants was that theoretical and practical education was not standard. ConclusionsThe skill perception level of emergency physicians regarding mechanical ventilation management is low. Having an intensive care unit in the emergency department or having a clinic chief who is an emergency physician as director increased the perception level of physicians who participated in an emergency medicine education program about mechanical ventilation management. Both the mechanical ventilation management education in emergency medicine education programs and the infrastructural conditions of emergency departments with respect to mechanical ventilation were considered to be inadequate by emergency physicians.

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Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients*

Abstract: Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation reduces intensive care unit length of stay and, in turn, decreases the incidence of complications of critical illness associated with prolonged intubation and mechanical ventilation.

Cited by 357 publications

References 31 publications

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention

Effects of early rehabilitation therapy on patients with mechanical ventilation

Mechanical Ventilation Practices of Turkish Emergency Physicians: A National Survey

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