title: Oversedation in postoperative patients requiring ventilator support greater than 48 hours: a 4-year National Surgical Quality Improvement Program-driven project.
abstract: Prolonged mechanical ventilation of postoperative patients can contribute to an increase in morbidity. Every effort should be made to wean patients from the ventilator after surgery. Oversedation may prevent successful extubation. Cases identified by the National Surgical Quality Improvement Program (NSQIP) for Huntington Hospital were reviewed. Oversedation, days on the ventilator, type and duration of sedation, and cost were studied. Data were collected from the NSQIP database and patient charts. Oversedation was determined by the Richmond Agitation Sedation Score (RASS) of each patient. The hospital pharmacy provided data on propofol. Forty-three (35%) patients were oversedated. Propofol was used in 111 (90%) cases with an average use of 4.8 days. Propofol was used greater than 48 hours in 77 (62%) cases. After identifying inconsistent nurse documentation of sedation, corrective actions helped decrease oversedation, average number of days on the ventilator, number of days on propofol, hospital expenditure on propofol, and number of patients on the ventilator greater than 48 hours. Oversedation contributed to prolonged mechanical ventilation. Standardization of RASS and physician sedation order sheets contributed to improving our NSQIP rating. Sedation use decreased and fewer patients spent less time on the ventilator. NSQIP is an effective tool to identify issues with quality in surgical patients.
authors.affiliation: Huntington Hospital, Pasadena, California, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Simpson
authors.forename: Steven G
authors.initials: SG
authors.lastname: Katz
authors.forename: Thomas Vander
authors.initials: TV
authors.lastname: Laan
mesh_terms: D002140:California; D054810:Deep Sedation / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D004334:Drug Administration Schedule; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D015742:Propofol / Q000008:administration & dosage*; D058996:Quality Improvement; D012121:Respiration, Artificial / Q000592:standards / Q000706:statistics & numerical data; D013997:Time Factors; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D015300:Ventilator Weaning / Q000592:standards / Q000706:statistics & numerical data*
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol