title: Evaluation of a clinical pathway for sedation and analgesia of mechanically ventilated patients in a cardiac intensive care unit (CICU): The Brigham and Women's Hospital Levine CICU sedation pathways.
abstract: BACKGROUND
  Intravenous sedation and analgesia are important therapies during mechanical ventilation (MV). However, daily interruption of these medications is associated with improved outcomes in mechanically ventilated patients. We tested a clinical pathway for the use of sedation and analgesia during MV in a cardiac intensive care unit (CICU).
  
  
  RESULTS
  We evaluated all mechanically ventilated patients in a CICU during two phases: phase 1 prior to pathway implementation (PRE) and phase 2 post-pathway implementation (POST). A total of 198 patients (98 PRE and 100 POST) and 1012 days of intubation (574 PRE and 434 POST) were included in this analysis. We found an increase in the frequency of daily interruptions of sedation post-implementation (49.3% PRE and 58.4% POST, p=0.0041). There was a significant decrease in the mean duration of MV in the POST vs PRE periods (5.0±2.3 vs 6.1±2.8 days, p=0.015). There was also a significant decrease in total neuroimaging studies (9 vs 49, p=0.001) and a trend toward a decrease in tracheostomies (3.0% vs 6.1%, p=0.33). Mean CICU length of stay (LOS) and hospital LOS respectively were 10.4 days and 16.8 days PRE and 10.4 days and 17.9 days POST (p=0.99 and p=0.55). Mortality did not differ (PRE 36.7% vs POST 32.0% p=0.55).
  
  
  CONCLUSIONS
  Implementation of a pragmatic pathway for sedation and analgesia in a CICU was associated with an increase in the daily interruption of sedation and a corresponding decrease in the duration of MV days and the need for neuroimaging.
authors: Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, USA.
authors: Aaron W
authors: AW
authors: Aday
authors: Heather
authors: H
authors: Dell'orfano
authors: Beth A
authors: BA
authors: Hirning
authors: Lina
authors: L
authors: Matta
authors: Molly H
authors: MH
authors: O'Brien
authors: Benjamin M
authors: BM
authors: Scirica
authors: Kathleen R
authors: KR
authors: Avery
authors: David A
authors: DA
authors: Morrow
mesh_terms: D000698:Analgesia / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D003325:Coronary Care Units / Q000379:methods*; D019091:Critical Pathways; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Mechanical ventilation; analgesia; clinical pathway; intensive care unit; sedation