title: The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation.
abstract: OBJECTIVE
  To determine whether the use of continuous i.v. sedation is associated with prolongation of the duration of mechanical ventilation.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  The medical ICU of Barnes-Jewish Hospital, a university-affiliated urban teaching hospital.
  
  
  METHODS
  Two hundred forty-two consecutive ICU patients requiring mechanical ventilation.
  
  
  METHODS
  Patient surveillance and data collection.
  
  
  RESULTS
  The primary outcome measure was the duration of mechanical ventilation. Secondary outcome measures included ICU and hospital lengths of stay, hospital mortality, and acquired organ system derangements. A total of 93 (38.4%) mechanically ventilated patients received continuous i.v. sedation while 149 (61.6%) patients received either bolus administration of i.v. sedation (n=64) or no i.v. sedation (n=85) following intubation. The duration of mechanical ventilation was significantly longer for patients receiving continuous i.v. sedation compared with patients not receiving continuous i.v. sedation (185+/-190 h vs 55.6+/-75.6 h; p<0.001). Similarly, the lengths of intensive care (13.5+/-33.7 days vs 4.8+/-4.1 days; p<0.001) and hospitalization (21.0+/-25.1 days vs 12.8+/-14.1 days; p<0.001) were statistically longer among patients receiving continuous i.v. sedation. Multiple linear regression analysis, adjusting for age, gender, severity of illness, mortality, indication for mechanical ventilation, use of chemical paralysis, presence of a tracheostomy, and the number of acquired organ system derangements, found the adjusted duration of mechanical ventilation to be significantly longer for patients receiving continuous i.v. sedation compared with patients who did not receive continuous i.v. sedation (148 h [95% confidence interval: 121, 175 h] vs 78.7 h [95% confidence interval: 68.9, 88.6 h]; p<0.001).
  
  
  CONCLUSIONS
  We conclude from these preliminary observational data that the use of continuous i.v. sedation may be associated with the prolongation of mechanical ventilation. This study suggests that strategies targeted at reducing the use of continuous i.v. sedation could shorten the duration of mechanical ventilation for some patients. Prospective randomized clinical trials, using well-designed sedation guidelines and protocols, are required to determine whether patient-specific outcomes (eg, duration of mechanical ventilation, patient comfort) can be improved compared with conventional sedation practices.
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Kollef
authors.forename: N T
authors.initials: NT
authors.lastname: Levy
authors.forename: T S
authors.initials: TS
authors.lastname: Ahrens
authors.forename: R
authors.initials: R
authors.lastname: Schaiff
authors.forename: D
authors.initials: D
authors.lastname: Prentice
authors.forename: G
authors.initials: G
authors.lastname: Sherman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008140:Lorazepam; D005283:Fentanyl