title: Pre- and post-intervention study to assess the impact of a sedation protocol in critically ill surgical patients.
abstract: BACKGROUND
  Sedation and pain management for mechanically ventilated critically ill surgical patients pose many challenges for the intensivist. Even though daily interruption of sedatives and opioids is appropriate in medical intensive care unit (ICU) patients, it may not be feasible in the surgical patients with pain from surgical incision or trauma. Therefore we developed an analgesia/sedation based protocol for the surgical ICU population.
  
  
  METHODS
  We performed a two-phase prospective observational control study. We evaluated a prescriber driven analgesia/sedation protocol (ASP) in a 12-bed surgical ICU. The pre-ASP group was sedated as usual (n = 100) and the post-ASP group was managed with the new ASP (n = 100). Each phase of the study lasted for 5 mo. Comparisons between the two groups were performed by χ(2) or Fisher's exact test for categorical variables and the Mann-Whitney test for nonparametric variables. A P value <0.05 was statistically significant.
  
  
  RESULTS
  We found a significant reduction in the use of fentanyl (P < 0.001) and midazolam (P = 0.001). We achieved sedation goals of 86.8% in the post-ASP group compared to 74.4% in the pre-ASP (P < 0.001). Mean mechanical ventilations days in pre- and post-ASP group were 5.9 versus 3.8 (P = 0.033).
  
  
  CONCLUSIONS
  In our cohort of critically ill surgery patients implementation of an ASP resulted in reduced use of continuously infused benzodiazepines and opioids, a decline in cumulative benzodiazepine and analgesic dosages, and a greater percentage of Richmond Agitation Sedation Scale scores at goal. We also showed reduced mechanical ventilation days.
authors.affiliation: VA Western New York Healthcare System & Rochester General Hospital, Division of Critical Care Medicine, Department of Anesthesiology & Surgery, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York. Electronic address: jahanpor@buffalo.edu.
authors.forename: Jahan
authors.initials: J
authors.lastname: Porhomayon
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
authors.forename: Ali A
authors.initials: AA
authors.lastname: El-Solh
authors.forename: Mindee
authors.initials: M
authors.lastname: Hite
authors.forename: Jonathan
authors.initials: J
authors.lastname: Scott
authors.forename: Kevin
authors.initials: K
authors.lastname: Silinskie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D015331:Cohort Studies; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D008874:Midazolam; D005283:Fentanyl
keywords: Dose; Fentanyl; Length of stay; Mechanical ventilation days; Midazolam; Protocol; Score; Sedation