Duration of mechanical ventilation in an adult intensive care unit after introduction of sedation and pain scales

Teresa Ann Williams, Suzanne Martin, Gavin Leslie, Linda Thomas, Timothy Leen, Sheralee Tamaliunas, K Y Lee, Geoffrey Dobb
American Journal of Critical Care 2008, 17 (4): 349-56

BACKGROUND: Sedation and analgesia scales promote a less-distressing experience in the intensive care unit and minimize complications for patients receiving mechanical ventilation.

OBJECTIVES: To evaluate outcomes before and after introduction of scales for sedation and analgesia in a general intensive care unit.

METHOD: A before-and-after design was used to evaluate introduction of the Richmond Agitation-Sedation Scale and the Behavioral Pain Scale for patients receiving mechanical ventilation. Data were collected for 6 months before and 6 months after training in and introduction of the scales.

RESULTS: A total of 769 patients received mechanical ventilation for at least 6 hours (369 patients before and 400 patients after implementation). Age, scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II, and diagnostic groups were similar in the 2 groups, but the after group had more men than did the before group. Duration of mechanical ventilation did not change significantly after the scales were introduced (median, 24 vs 28 hours). For patients who received mechanical ventilation for 96 hours or longer (24%), mechanical ventilation lasted longer after implementation of the scales (P=.03). Length of stay in the intensive care unit was similar in the 2 groups (P= .18), but patients received sedatives for longer after implementation (P=.01). By logistic regression analysis, APACHE II score (P<.001) and diagnostic group (P<.001) were independent predictors of mechanical ventilation lasting 96 hours or longer.

CONCLUSION: Sedation and analgesia scales did not reduce duration of ventilation in an Australian intensive care unit.

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