Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia*

Abstract

In patients receiving mechanical ventilation and requiring sedative infusions with midazolam or propofol, the use of a nurse-implemented sedation protocol decreases the rate of VAP and the duration of mechanical ventilation.

The Vexing Problem of Ventilator-Associated Pneumonia: Observations on Pathophysiology, Public Policy, and Clinical Science

“…Observational studies from both medical and surgical ICUs have reported that spontaneous breathing trials and targeted/daily sedation interruptions (irrespective of other VAP prevention measures) reduced the prevalence of VAP from ϳ15 to 5%. This corresponded with a decrease in the mean duration of mechanical ventilation to fewer than 5 d. 105,106 In another study, targeted sedation reduced the average duration of mechanical ventilation from 10.3 to 4.4 d with a corresponding trend toward reduced VAP from 20.4 to 8.3% (P ϭ .10). 107 …”

Hipotermia intravascular prolongada en un paciente con hipertensión endocraneana refractaria

“…De hecho, su uso requiere el empleo de una sedación profunda y muchas veces asociada a bloqueo neuromuscular, para evitar los calofríos que aumentan signifi cativamente el consumo de oxígeno 7,20 . Sólo la sedación y el bloqueo neuromuscular, administrados en forma protocolizada contra un objetivo de sedación moderada, han demostrado reducir el número de días en ventilación mecánica 21 y la probabilidad de neumonía asociada al ventilador mecánico (NAV) 22 . Sin embargo, su uso durante hipotermia está asociado a un objetivo de sedación profunda 23 , por lo que puede contribuir tanto al aumento de NAV 24 como de polineuromiopatía 25 .…”

Gender-specific differences in nursing staff’s administration patterns of ‘pro re nata’ medication: A prospective observational study

“…Bedside nurses can be in charge for the administration of PRN medication, given that they are present at the bedside more often than the physicians [11,14,15]. This has been shown to lead to a quicker treatment, in case that PRN medication can be given autonomously by the nurses within the limits of the physician's prescription [11,[15][16][17][18]. Consequently, this comes along with a high grade of freedom of action and responsibility for the care staff [10,12,19].…”

“…Furthermore, the prescription pattern of PRN might be influenced by beliefs, attitudes, perceived norms, perceived behavioral control, intentions, and experience. Bedside nurses can be in charge for the administration of PRN medication, given that they are present at the bedside more often than the physicians [11,14,15]. This has been shown to lead to a quicker treatment, in case that PRN medication can be given autonomously by the nurses within the limits of the physician's prescription [11,[15][16][17][18].…”