Sedation algorithm in critically ill patients without acute brain injury.
OBJECTIVE
To determine whether use of a sedation algorithm to promote a high level of tolerance to the intensive care environment and preserve consciousness affected time to arousal and duration of mechanical ventilation in patients without acute brain injury.


METHODS
Two-phase, prospective, controlled study.


METHODS
University-affiliated medical intensive care unit.


METHODS
: Patients without acute brain injury requiring mechanical ventilation for at least 24 hrs.


METHODS
During the control phase, sedatives and analgesics were adjusted according to the physician's decision. During the algorithm phase, sedatives and analgesics were adjusted according to an algorithm developed by a multidisciplinary team including nurses and physicians. The algorithm was based on regular assessments of consciousness and tolerance to the intensive care unit environment using the Adaptation to Intensive Care Environment instrument and was designed to achieve tolerance and maintain a high level of consciousness. Standard practices, including weaning from the ventilator, were the same during both study phases.


RESULTS
A total of 102 patients were enrolled (control group, n = 54; algorithm group, n = 48). Median duration of mechanical ventilation was significantly shorter in the algorithm group (4.4 days [interquartile range, 2.1-9.8]) compared with the control group (10.3 days [3.5-17.2], p = .014), representing a 57.3% reduction. In Cox multivariate analysis, the risk of remaining on mechanical ventilation was 0.48 times (95% confidence interval, 0.29-0.78) lower for algorithm patients compared with controls. The median time to arousal was also significantly shorter in patients in the algorithm group (2 days [2-5]) compared with the control group (4 days [2-9], p = .006).


CONCLUSIONS
The use of a sedation algorithm to promote tolerance to the intensive care environment and preserve consciousness in patients without acute brain injury resulted in a marked decrease in the duration of mechanical ventilation. This reduction was at least partly attributable to a shorter time to arousal after initiation of mechanical ventilation.
De Jonghe
Bernard
B
Medical Intensive Care Unit, Poissy Hospital, Poissy, France.
Bastuji-Garin
Sylvie
S
Fangio
Pascal
P
Lacherade
Jean-Claude
JC
Jabot
Julien
J
Appéré-De-Vecchi
Corinne
C
Rocha
Nathalie
N
Outin
Hervé
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001143:Arousal / Q000187:drug effects; D001925:Brain Damage, Chronic / Q000628:therapy*; D016292:Procedural Sedation / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005602:France; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010147:Pain Measurement; D010348:Patient Care Team; D011446:Prospective Studies; D012121:Respiration, Artificial
D008874:Midazolam; D005283:Fentanyl