title: The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit.
abstract: OBJECTIVE
  To examine the effect of an algorithm-based sedation guideline developed in a North American intensive care unit (ICU) on the duration of mechanical ventilation of patients in an Australian ICU.
  
  
  METHODS
  The intervention was tested in a pre-intervention, post-intervention comparative investigation in a 14-bed adult intensive care unit.
  
  
  METHODS
  Adult mechanically ventilated patients were selected consecutively (n=322). The pre-intervention and post-intervention groups were similar except for a higher number of patients with a neurological diagnosis in the pre-intervention group.
  
  
  METHODS
  An algorithm-based sedation guideline including a sedation scale was introduced using a multifaceted implementation strategy.
  
  
  RESULTS
  The median duration of ventilation was 5.6 days in the post-intervention group, compared with 4.8 days for the pre-intervention group (P=0.99). The length of stay was 8.2 days in the post-intervention group versus 7.1 days in the pre-intervention group (P=0.04). There were no statistically significant differences for the other secondary outcomes, including the score on the Experience of Treatment in ICU 7 item questionnaire, number of tracheostomies and number of self-extubations. Records of compliance to recording the sedation score during both phases revealed that patients were slightly more deeply sedated when the guideline was used.
  
  
  CONCLUSIONS
  The use of the algorithm-based sedation guideline did not reduce duration of mechanical ventilation in the setting of this study.
authors.affiliation: The Royal North Shore Hospital, Intensive Care Unit, Sydney, NSW 2065, Australia. rmelliot@nsccahs.health.nsw.gov.au
authors.forename: Rosalind
authors.initials: R
authors.lastname: Elliott
authors.forename: Sharon
authors.initials: S
authors.lastname: McKinley
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Aitken
authors.forename: Joan
authors.initials: J
authors.lastname: Hendrikz
mesh_terms: D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009517:New South Wales; D012121:Respiration, Artificial; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives