title: [Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation].
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.
  
  
  OBJECTIVE
  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).
  
  
  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.
authors.affiliation: Unidad de Paciente Crítico, Hospital Clínico Universidad de Chile, Santos Dumont 999, Santiago, Chile. edotobar@gmail.com
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tobar A
authors.forename: Alejandra
authors.initials: A
authors.lastname: Lanas M
authors.forename: Sandra
authors.initials: S
authors.lastname: Pino P
authors.forename: Paulina
authors.initials: P
authors.lastname: Aspée L
authors.forename: Sandra
authors.initials: S
authors.lastname: Rivas V
authors.forename: Daniela
authors.initials: D
authors.lastname: Prat R
authors.forename: Rosmi
authors.initials: R
authors.lastname: Asenjo B
authors.forename: José
authors.initials: J
authors.lastname: Castro O