Pre- and post-intervention study to assess the impact of a sedation protocol in critically ill surgical patients

Porhomayon, Jahan; Nader, Nader D.; El-Solh, Ali; Hite, Mindee; Scott, J Brady; Silinskie, Kevin

doi:10.1016/j.jss.2013.03.065

Cited by 15 publications

(23 citation statements)

References 30 publications

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“…Protocols to guide care in critically ill patients have been used with success in other areas, including ventilator weaning, 63,64 intensive insulin therapy, 65 and sedation management. 66,67 Nutrition support protocols are effective in increasing the amount of nutrients provided to critically ill patients, 21,[68][69][70] and decreasing the amount of time necessary to reach target nutrition goals. 24,71 The use of an evidence-based nutrition support protocol provides nurses with guidance when addressing issues commonly encountered with enteral feedings, including initiation of feedings, feeding intolerance, and advancement and discontinuation of enteral nutrition.…”

Section: Nutrition Support Protocolsmentioning

confidence: 99%

Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Stewart

2014

Critical Care Nurse

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M alnutrition results when nutritional intake does not meet metabolic requirements. Critically ill patients are at an increased risk for malnutrition because of alterations in protein and energy metabolism displayed in response to trauma, major surgery, burns, and sepsis 1 and may be unable to tolerate oral nutrition. Critical care nurses are well positioned to screen patients at risk for malnutrition and to work in conjunction with the multidisciplinary team to develop and implement interventions to prevent and treat malnutrition. Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice MELISSA L. STEWART, RN, DNP, MSN, CCNS, CCRNThis article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. List consequences of malnutrition in critically ill patients 2. Discuss how current nursing routines may contribute to interruptions in enteral nutrition in critically ill patients 3. Describe nursing interventions to improve the delivery of nutrition to critically ill patients CNE Continuing Nursing EducationCover Malnutrition is common in critically ill patients and is associated with poor outcomes for patients and increased health care spending. Enteral nutrition is the method of choice for nutrition delivery. Enteral nutrition delivery practices vary widely, and underfeeding is widespread in critical care. Interruptions in enteral nutrition due to performance of procedures, positioning, technical issues with feeding accesses, and gastrointestinal intolerance contribute to underfeeding. Strategies such as head-of-bed positioning, use of prokinetic agents, tolerance of higher gastric residual volumes, consideration of postpyloric feeding access, and use of a nutrition support protocol may decrease time spent without nutrition. (Critical Care Nurse.

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Section: Nutrition Support Protocolsmentioning

confidence: 99%

Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Stewart

2014

Critical Care Nurse

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“…In addition, daily sedation interruption has been shown to decrease the incidence of complications associated with mechanical ventilation and prolonged intubation ( Schweickert, Gehlbach, Pohlman, Hall, & Kress, 2004 ). The effect of reduction in ventilator days may be partially attributed to the reduction in accumulation of active metabolites of the continuous infusions ( Porhomayon et al, 2013 ;Shafer, 1998 ) and a reduction in ICU delirium ( Ouimet, Kavanaugh, Gottfried, & Skrobik, 2007 ).…”

Section: Continuous Versus Intermittent Sedationmentioning

confidence: 99%

“…These samples include critically ill patients with older median ages compared with surgical and trauma patient populations ( Porhomayon et al, 2013 ;Robinson et al, 2008 ); thus, the findings may not be generalizable to these groups. In orthopedic, general surgery, and cardiac surgery patients, an analgosedation methodology has been noted to reduce agitation when analgesia needs are addressed upfront ( Vogt & Frankel, 2014 ).…”

Section: Continuous Versus Intermittent Sedationmentioning

confidence: 99%

“…Generally, critically ill patients experience pain from routine care and necessary medical procedures ( Brush & Kress, 2009 ;Vogt & Frankel, 2014 ). However, the pain experienced by traumatically injured patients is a consequence of surgical management, the systemic inflammatory response, and the injury itself ( Glowacki, 2015 ;Malchow & Black, 2008 ;Porhomayon et al, 2013 ). Complications of inadequate pain management include venous thrombotic events, pulmonary complications, exacerbated stress response, posttraumatic stress disorder, and an increase in agitation, length of stay, and mortality rates ( Malchow & Black, 2008 ).…”

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confidence: 99%

“…The development of a nurse-driven analgosedation guideline was noted to be both feasible and successful. & Kress, 2009 ;Hughes, Girard, & Pandharipande, 2013 ;Porhomayon et al, 2013 ;Robinson, Berube, Barr, Riker, & Gelinas, 2013 ;Robinson et al, 2008 ).…”

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confidence: 99%

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Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit

Sacco

LaRiccia

2016

Journal of Trauma Nursing

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Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial. During this time, unit champions were integral to successful trial execution. Outcome measurement included patient and unit outcomes, nursing satisfaction, and a pre- and postimplementation patient comparison. Following implementation, unit length of stay decreased by 4.16% and there was a 17.81% decrease in average time on the ventilator following the initiation of weaning. Patient reports of nurse sensitivity and responsiveness to pain increased from 93.7 to 94.9. Nurses reported satisfaction with the practice change and improvements in care. In comparing pre- and postimplementation patient data, there was a significant decrease in mean analgesic treatment duration and an increase in the use of antipsychotics for delirium management. Following the trial period, this guideline was permanently adopted across the adult critical care service. The development of a nurse-driven analgosedation guideline was noted to be both feasible and successful.

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Impact of Sedation on Cognitive Function in Mechanically Ventilated Patients

Porhomayon

El-Solh

Adlparvar

et al. 2015

Lung

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The practice of sedation dosing strategy in mechanically ventilated patient has a profound effect on cognitive function. We conducted a comprehensive review of outcome of sedation on mental health function in critically ill patients on mechanical ventilation in the intensive care unit (ICU). We specifically evaluated current sedative dosing strategy and the development of delirium, post-traumatic stress disorders (PTSDs) and agitation. Based on this review, heavy dosing sedation strategy with benzodiazepines contributes to cognitive dysfunction. However, outcome for mental health dysfunction is mixed in regard to newer sedatives agents such as dexmedetomidine and propofol. Moreover, studies that examine the impact of sedatives for persistence of PTSD/delirium and its long-term cognitive and functional outcomes for post-ICU patients are frequently underpowered. Most studies suffer from low sample sizes and methodological variations. Therefore, larger randomized controlled trials are needed to properly assess the impact of sedation dosing strategy on cognitive function.

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Pre- and post-intervention study to assess the impact of a sedation protocol in critically ill surgical patients

Cited by 15 publications

References 30 publications

Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit

Impact of Sedation on Cognitive Function in Mechanically Ventilated Patients

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