ABSTRACT
BACKGROUND: Sedatives and analgesic drugs give comfort and allow adequate respiratory support to critically ill patients in mechanical ventilation (MV). Its improper use may increase the duration of MV. Clinical guidelines suggest implementation of protocols, however this is seldom done in clinical practice. AIM: To compare in MV patients, nurse-applied guided by protocol administration of sedatives and analgesic drugs (protocol: group P) with the habitual practice using physicians criteria (control: group C). MATERIAL AND METHODS: Inclusion criteria was the need of MV more than 48 h. The exclusion criteria were acute neurological diseases, hepatic cirrhosis, chronic renal failure and limitation of therapeutic efforts. Midazolam and fentanyl were used in both groups. The level of sedation was monitored with the Sedation Agitation Scale (SAS). In the P group, trained nurses applied algorithms to adjust the sedative doses according to a predefined SAS goal. RESULTS: Forty patients were included, 22 aged 65+/-19 years in group P and 18 aged 54+/-21 years in group C. Apache II scores were 16+/-8 and 19+/-8 in each group. SAS score was more frequently evaluated within goal boundaries in group P than in group C (44% and 32%, respectively p =0.001). No differences in the proportion of patients with inadequate sedation were observed between treatment groups. Midazolam doses were lower in P than in C group (0.04 (0.02-0.07) and 0.06 (0.03-0.08) mg/kg/h respectively, p =0.005). CONCLUSIONS: The implementation of sedation protocol applied by nurses improved the quality of sedation and reduced the doses of Midazolam in mechanically ventilated patients.
Subject(s)
Analgesia/methods , Analgesics, Opioid/administration & dosage , Conscious Sedation/methods , Critical Illness/therapy , Hypnotics and Sedatives/administration & dosage , Respiration, Artificial , APACHE , Aged , Algorithms , Conscious Sedation/classification , Critical Illness/nursing , Deep Sedation/classification , Deep Sedation/methods , Fentanyl/administration & dosage , Humans , Midazolam/administration & dosage , Middle Aged , Nursing Care/standards , Practice Guidelines as Topic/standards , Psychomotor Agitation/classificationABSTRACT
Background: Sedatives and analgesic drugs give comfort and allow adequate respiratory support to critically ill patients in mechanical ventilation (MV). Its improper use may increase the duration of MV. Clinical guidelines suggest implementation of protocols, however this is seldom done in clinical practice. Aun: To compare in MV patients, nurse-applied guided by protocol administration of sedatives and analgesic drugs (protocol: group P) with the habitual practice using physicians criteria (control: group C). Material and methods: Inclusión criteria was the need of MV more than 48 h. The exclusión criteria were acute neurological diseases, hepatic cirrhosis, chronic renal failure and limitation of therapeutic efforts. Midazolam and fentanyl were used in both groups. The level of sedation was monitored with the Sedation Agitation Scale (SAS). In the P group, trained nurses applied algorithms to adjust the sedative doses according to a predefined SAS goal. Results: Forty patients were included, 22 aged 65±19 years in group P and 18 aged 54±21 years in group C. Apache II scores were 16±8 and 19±8 in each group. SAS score was more frequently evaluated within goal boundaries in group P than in group C (44 percent and 32 percent, respectively p =0.001). No differences in the proportion of patients with inadequate sedation were observed between treatment groups. Midazolam doses were lower in P than in C group (0.04 (0.02-0.07) and 0.06 (0.03-0.08) mg/kg/h respectively, p =0.005). Conclusions: The implementation of sedation protocol applied by nurses improved the quality of sedation and reduced the doses of Midazolam in mechanically ventilated patients.
Subject(s)
Aged , Humans , Middle Aged , Analgesia/methods , Analgesics, Opioid/administration & dosage , Conscious Sedation/methods , Critical Illness/therapy , Hypnotics and Sedatives/administration & dosage , Respiration, Artificial , APACHE , Algorithms , Conscious Sedation/classification , Critical Illness/nursing , Deep Sedation/classification , Deep Sedation/methods , Fentanyl/administration & dosage , Midazolam/administration & dosage , Nursing Care/standards , Practice Guidelines as Topic/standards , Psychomotor Agitation/classificationABSTRACT
Pacientes agitados são presença constante na prática médica. Portanto, é fundamental que pessoas relacionadas a essa área tenham conhecimento acerca do tema. Nesse trabalho serão discutidos conceitos, etiologia, manejo e outras particularidades a respeito do tema. Os autores realizam uma revisão bibliográfica em livros textos e artigos recentes