Sedation in Adults Receiving Mechanical Ventilation: Physiological and Comfort Outcomes

Abstract

Objective To describe the relationships among sedation, stability in physiological status, and comfort during a 24-hour period in patients receiving mechanical ventilation. Methods Data from 169 patients monitored continuously for 24 hours were recorded at least every 12 seconds, including sedation levels, physiological status (heart rate, respiratory rate, oxygen saturation by pulse oximetry), and comfort (movement of arms and legs as measured by actigraphy). Generalized linear mixed-effect models were used to estimate the distribution of time spent at various heart and respiratory rates and oxygen saturation and actigraphy intervals overall and as a function of level of sedation and to compare the percentage of time in these intervals between the sedation states. Results Patients were from various intensive care units: medical respiratory (52%), surgical trauma (35%), and cardiac surgery (13%). They spent 42% of the time in deep sedation, 38% in mild/moderate sedation, and 20% awake/alert. Distributions of physiological measures did not differ during levels of sedation (deep, mild/moderate, or awake/alert: heart rate, P = .44; respirations, P = .32; oxygen saturation, P = .51). Actigraphy findings differed with level of sedation (arm, P < .001; leg, P = .01), with less movement associated with greater levels of sedation, even though patients spent the vast majority of time with no arm movement or leg movement. Conclusions Level of sedation most likely does not affect the stability of physiological status but does have an effect on comfort.

Towards a Standardized Approach for Critical Care Nursing Practices: Development of Evidence Based Analgo-Sedation Guidelines for Adult Mechanically Ventilated Patients

“…[52] These findings suggest a widespread culture of keeping mechanically ventilated ICU patients at deep levels of sedation in order to facilitate ICU patient care activities. The results of the current study are in agreement with Payen et al (2007) [2] who found that 41% to 57% of assessed patients were in a deep sedation state and Grap et al (2012) [53] who observed that patients spent 80% of the time in mild/deep sedation and only 20% awake/alert. It was found during the present study that all patients experienced pain all over the study period and the pain score was remained within moderate level using CPOT.…”

Insights and Advances in Multidisciplinary Critical Care: A Review of Recent Research

“…Sedation is inherently associated with mechanical ventilation. Grap and colleagues 16 investigated the relationships among sedation, stability in physiological status, and comfort as assessed by using actigraphy to measure limb movement. Level of sedation did not influence physiological measures, but actigraphy findings differed with depth of sedation, reflecting higher comfort levels in deeply sedated patients.…”

Assessment of the Effect of Continuous Sedation with Mechanical Ventilation on Adrenal Insufficiency in Patients with Traumatic Brain Injury

“…Furthermore, the role of activation of afferent fibers of the autonomic nervous system could be explored in experiments with pharmacological or surgical manipulations of the noradrenergic and vagus systems. Grap et al 26 had suggested that the level of sedation most likely does not affect the stability of physiological status but does have an effect on comfort. However, we cannot provide explanations for the data on severity of patients measured with APACHE and need of mechanical ventilation and sedation.…”