Effect of an analgo-sedation protocol for neurointensive patients: a two-phase interventional non-randomized pilot study.
BACKGROUND
Sedation protocols are needed for neurointensive patients. The aim of this pilot study was to describe sedation practice at a neurointensive care unit and to assess the feasibility and efficacy of a new sedation protocol. The primary outcomes were a shift from sedation-based to analgesia-based sedation and improved pain management. The secondary outcomes were a reduction in unplanned extubations and duration of sedation.


METHODS
This was a two-phase (before-after), prospective controlled study at a university-affiliated, 14-bed neurointensive care unit in Denmark. The sample included patients requiring mechanical ventilation for at least 48 hours treated with continuous sedative and analgesic infusions or both. During the observation phase the participants (n = 106) were sedated as usual (non-protocolized), and during the intervention phase the participants (n = 109) were managed according to a new sedation protocol.


RESULTS
Our study showed a shift toward analgo-sedation, suggesting feasibility of the protocol. We found a significant reduction in the use of propofol (P < .001) and midazolam (P = .001) and an increase in fentanyl (P < .001) and remifentanil (P = .003). Patients selected for daily sedation interruption woke up faster, and estimates of pain free patients increased from 56.8% to 82.7% (P < .001), suggesting efficacy of the protocol. The duration of sedation and unplanned extubations were unchanged.


CONCLUSIONS
Our pilot study showed feasibility and partial efficacy of our protocol. Some neurointensive patients might not benefit from protocolized practice. We recommend an interdisciplinary effort to target patients requiring less sedation, as issues of oversedation and inadequate pain management still need more attention.


BACKGROUND
ISRCTN80999859.
Egerod
Ingrid
I
Copenhagen University Hospital, Rigshospitalet, Department 7331, UCSF, Blegdamsvej 9, Copenhagen O, Denmark. ie@ucsf.dk
Jensen
Malene Brorsen
MB
Herling
Suzanne Forsyth
SF
Welling
Karen-Lise
KL
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D002985:Clinical Protocols; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
D000700:Analgesics; D006993:Hypnotics and Sedatives
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