Safety and efficacy of a nurse-driven sedation protocol with daily sedation interruption in the ICU

Introduction

Sedation algorithms have been shown to reduce the duration of mechanical ventilation in the ICU. We evaluated the effect of the implementation of a nurse-driven sedation protocol with daily sedation interruption in our ICU.

Methods

We performed a before-and-after prospective study in our eight-bed medical ICU over a 6-month period. All patients requiring mechanical ventilation and who were not receiving neuromuscular blocking agents were included. Prior to implementation, sedation was adjusted according to physician orders. During the intervention period, sedatives and analgesics were adjusted by nurses according to an algorithm utilizing the Sedation-Agitation Scale.

Results

We included a total of 188 patients, 89 patients in the observational period and 99 patients during the intervention period. The duration of mechanical ventilation was similar (2 days in both groups). However, the ICU length of stay (LOS) was reduced by a day after implementation (3 days vs 2 days). Amongst patients who survived and who were mechanically ventilated for more than 4 days, the duration of mechanical ventilation and ICU LOS were reduced (7 days vs 6 days and 8 days vs 6 days, respectively). Fewer CT brains were performed for persistent coma after discontinuation of sedation in the intervention period (4.5% vs 1.2%). Complications such as extubation failure, tracheostomy and inadvertent removal of devices were similar in both groups.

Conclusions

A nurse-driven sedation protocol is safe and may reduce duration of mechanical ventilation and ICU LOS, especially amongst patients who have been ventilated for more than 4 days.