Week 4 – ICU sedation

Many mechanically ventilated patients in the ICU receive sedative drugs to decrease anxiety, provide comfort, and ease treatments. The exact level of sedation varies depending on the medical condition of the patient and their specific treatment needs. The level of sedation is measured by nurses or physicians according to the Ramsay scale or the Richmond agitation sedation scale (RASS). Jackson, Proudfoot, Cann, and Walsh investigated the impact of sedation practices on both patient safety and economic outcomes through a systematic review of literature. The review indicated a strong association between duration of ICU stay and ventilation times. There was also evidence of reduction in ICU-acquired pneumonia and short-term mortality in many cases. Daily sedation breaks deemed beneficial to patients as well. The quality and nature of standard care, and patient case are important determinants on the impact of changes within individual ICUs. Sedation practice is likely to influence health care costs and the improvement of sedation practice benefits not only the patient, but also reduces costs.

I agree with the article that there is a strong association between duration of ICU stay and ventilation times because the longer that patients are on a ventilator, the longer their stay in the hospital becomes. I’ve had a patient who was on a ventilator for numerous weeks and ended up being in the hospital for over 2 months. The next step is to find other alternatives for ventilated patients besides sedation in order to shorten their hospital stay.

 

References:

Jackson, D. L., Proudfood, C.W., Cann, K.F., & Walsh, T. (2010). A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety. Critical Care, 14(2). doi:10.1186/cc8956