No-sedation during mechanical ventilation: impact on patient's consciousness, nursing workload and costs.

BACKGROUND: Evidence is growing that less or no-sedation is possible and beneficial for patients during mechanical ventilation. AIM: To investigate if there was a difference in patient consciousness and nursing workload comparing a group of patients receiving no-sedation with a group of sedated patients with daily wake up, and also to estimate economic consequences of a no-sedation strategy. DESIGN AND METHODS: Data were collected during a prospective trial of 140 mechanically ventilated patients randomized to either no-sedation or to sedation with daily wake up. From day 1 to 7 in the intensive care unit (ICU), patients were Richmond Agitation and Sedation Scale (RASS) scored, nursing workload was measured with the Nursing Care Recording System (NCR11) and nurse's self-assessment of workload was reported on a Numeric Rating Scale from 1 (low) to 10 (high). RESULTS: Patients from the no-sedation group had a median RASS score of -0·029 compared with -2 in the sedated group (P < 0·00001). The NCR11 scores were higher in the sedated group compared with the no-sedation group: 19·054 versus 17·05 (P = 0·00001). The nurses self-reported workload was the same in both groups (P = 0·085). Because of a shorter ICU stay and shorter hospital length of stay in the no-sedation group, we estimated that there will be no cost benefit with the use of sedation and a higher patient to nurse ratio. CONCLUSION: Patients receiving no-sedation were more awake with a RASS score close to zero, compared with patients receiving sedation and daily wake up. Nurses reported no difference in self-assessed workload between the no-sedation and sedated group of patients. RELEVANCE TO CLINICAL PRACTICE: Patients receiving no-sedation are more awake during their stay in ICU. There might be a potential economical saving with the use of a 1:1 nurse-patient ratio and no-sedation compared with sedation and a 1:2 nurse-patient ratio.

Assessment of quality of life for frail, elderly patients post-ICU discharge: a protocol for a scoping review.

INTRODUCTION: Rises in average life expectancy, increased comorbidities and frailty among older patients lead to higher admission rates to intensive care units (ICU). During an ICU stay, loss of physical and cognitive functions may occur, causing prolonged rehabilitation. Some functions may be lost permanently, affecting quality of life (QoL). There is a lack of understanding regarding how many variables are relevant to health-related outcomes and which outcomes are significant for the QoL of frail, elderly patients following discharge from the ICU. Therefore, this scoping review aims to identify reported variables for health-related outcomes and explore perspectives regarding QoL for this patient group. METHODS AND ANALYSIS: The Joanna Briggs Institute guidelines for scoping reviews will be employed and original, peer-reviewed studies in English and Scandinavian languages published from 2013 to 2023 will be included. The search will be conducted from July 2023 to December 2023, according to the inclusion criteria in Embase, MEDLINE, PsycINFO and CINAHL. References to identified studies will be hand-searched, along with backward and forward citation searching for systematic reviews. A librarian will support and qualify the search strategy. Two reviewers will independently screen eligible studies and perform data extraction according to predefined headings. In the event of disagreements, a third reviewer will adjudicate until consensus is achieved. Results will be presented narratively and in table form and discussed in relation to relevant literature. ETHICS AND DISSEMINATION: Ethical approval is unnecessary, as the review synthesises existing research. The results will be disseminated through a peer-reviewed publication in a scientific journal.

Sedation versus no sedation: Are there differences in relatives' satisfaction with the Intensive Care Unit? A survey study based on data from a randomised controlled trial.

BACKGROUND: Currently there is a trend towards less or no use of sedation of mechanically ventilated patients. Still, little is known about how different sedation strategies affect relatives' satisfaction with the Intensive Care Unit (ICU). AIM: To explore if there was a difference in relatives' personal reactions and the degree of satisfaction with information, communication, surroundings, care and treatment in the ICU between relatives of patients who receive no sedation compared with relatives of patients receiving sedation during mechanical ventilation in the ICU. METHOD: A survey study using a questionnaire with 39 questions was distributed to relatives of mechanically ventilated patients, who had been randomised to either sedation with daily wake up or no sedation. RESULTS: Forty-nine questionnaires were sent out and 36 relatives answered. The response rate was 73%. We found no differences in relatives' personal reactions or in the degree of satisfaction with information, communication, care and treatment in the ICU between relatives of patients in the two groups. Relatives of patients treated with no sedation felt more bothered by disturbances in the surroundings compared with relatives of patients who were sedated (p=0.03). CONCLUSION: Treating the patient during mechanical ventilation with no sedation does not affect relatives' satisfaction adversely.