Impact of nursing education by a pharmacist on sedation practice in a trauma surgical intensive care unit.

INTRODUCTION: Benefits of pharmacist-provided education on nurse-driven sedation protocols have not been assessed. METHODS: Trauma intensive care unit nurses received pharmacist-provided education on the hospital's sedation protocol. Sedation outcomes were assessed for patients in the preeducation (n = 29) and posteducation (n = 33) groups. RESULTS: The primary outcome of sedation scores at goal was not significantly different (41% vs 60%; P = .169), while more patients experienced oversedation (50% vs 32%; P = .013) in the pre- vs posteducation groups, respectively. No patient experienced self-extubation. CONCLUSIONS: Despite similar achievement of goal sedation scores before and after pharmacist-provided education, the posteducation group experienced fewer incidences of oversedation with no difference in self-extubation.

Evaluation of feeding intolerance in patients with pentobarbital-induced coma.

BACKGROUND: There is considerable debate regarding the appropriateness of feeding patients by the enteral route in conjunction with pentobarbital coma therapy. OBJECTIVE: To determine the incidence of feeding intolerance (FI) in patients receiving pentobarbital in conjunction with enteral nutrition (EN). METHODS: A retrospective, observational evaluation of patients (>14 y of age) who received a therapeutic pentobarbital coma in combination with EN was conducted. Patients were divided into groups, based on the occurrence of FI defined as aspiration of gastric residuals greater than 75 mL for 2 consecutive measurements. RESULTS: Forty-eight percent (29 of 61) of patients experienced FI based on our definition. The median pentobarbital infusion rate did not differ significantly between patients who experienced FI versus those who did not (median [intraquartile range, IQR] 1.8 mg/kg/h [1.4, 2.1] vs 1.7 mg/kg/h [1.4, 2.5]; p = 0.680). The total pentobarbital bolus dose during the first 24 hours of therapy was lower in patients who experienced FI (700 mg [225, 980] vs 1000 mg [600, 1475]; p = 0.029). Median duration of pentobarbital therapy was comparable between groups (141.0 h [93.3, 217.3] vs 116.3 h [64.0, 174.8]; p = 0.115). Other factors with the potential to influence FI, such as catecholamines, neuromuscular blockade, and hyperglycemia, were similar between groups. The higher narcotic doses and greater percentage of patients receiving benzodiazepines in the FI group warrants further study. CONCLUSIONS: Pentobarbital therapy did not preclude use of EN in the entire study population. In addition, FI did not occur at a greater frequency in patients who received a higher dosage, a longer duration, or an earlier initiation of pentobarbital therapy.