Chest
Volume 114, Issue 2, August 1998, Pages 541-548
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Clinical Investigations In Critical Care
The Use of Continuous IV Sedation Is Associated With Prolongation of Mechanical Ventilation

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Study objective

To determine whether the use of continuous IV sedation is associated with prolongation of the duration of mechanical ventilation.

Design

Prospective observational cohort study.

Setting

The medical ICU of Barnes-Jewish Hospital, a university-affiliated urban teaching hospital.

Patients

Two hundred forty-two consecutive ICU patients requiring mechanical ventilation.

Interventions

Patient surveillance and data collection.

Measurements and results

The primary outcome measure was the duration of mechanical ventilation. Secondary outcome measures included ICU and hospital lengths of stay, hospital mortality, and acquired organ system derangements. A total of 93 (38.4%) mechanically ventilated patients received continuous IV sedation while 149 (61.6%) patients received either bolus administration of IV sedation (n=64) or no IV sedation (n=85) following intubation. The duration of mechanical ventilation was significantly longer for patients receiving continuous IV sedation compared with patients not receiving continuous IV sedation (185±190 h vs 55.6±75.6 h; p<0.001). Similarly, the lengths of intensive care (13.5±33.7 days vs 4.8±4.1 days; p<0.001) and hospitalization (21.0±25.1 days vs 12.8± 14.1 days; p<0.001) were statistically longer among patients receiving continuous IV sedation. Multiple linear regression analysis, adjusting for age, gender, severity of illness, mortality, indication for mechanical ventilation, use of chemical paralysis, presence of a tracheostomy, and the number of acquired organ system derangements, found the adjusted duration of mechanical ventilation to be significantly longer for patients receiving continuous IV sedation compared with patients who did not receive continuous IV sedation (148 h [95% confidence interval: 121, 175 h] vs 78.7 h [95% confidence interval: 68.9, 88.6 h]; p<0.001).

Conclusion

We conclude from these preliminary observational data that the use of continuous IV sedation may be associated with the prolongation of mechanical ventilation. This study suggests that strategies targeted at reducing the use of continuous IV sedation could shorten the duration of mechanical ventilation for some patients. Prospective randomized clinical trials, using well-designed sedation guidelines and protocols, are required to determine whether patient-specific outcomes (eg, duration of mechanical ventilation, patient comfort) can be improved compared with conventional sedation practices.

Section snippets

Study Location and Patients

The study was conducted at a university-affiliated urban teaching hospital: Barnes-Jewish Hospital (1,400 beds). During a 5-month period (August 1997 to December 1997), all patients receiving mechanical ventilation in the medical ICU (19 beds) were potentially eligible for this investigation. Patients were entered into the investigation if they were >17 years and excluded if they were temporarily admitted (ie, <24 h) to the medical ICU from a surgical service while awaiting a surgical ICU bed.

Patients

A total of 242 consecutive patients requiring mechanical ventilation were evaluated. The mean age of the patients was 56.3± 17.5 years (range, 18 to 105 years). The mean APACHE II score was 20.8±8.1 (range, 1 to 59). One hundred twenty-one (50%) patients were men and 121 (50.0%) were women. The indications for mechanical ventilation included respiratory failure due to pneumonia (20.2%), drug overdose (8.3%), ARDS or ALI associated with sepsis or aspiration (13.6%), COPD or asthma (22.7%),

Discussion

We demonstrated a statistically significant association between the use of continuous IV sedation and the duration of mechanical ventilation. Even after adjusting for potential confounding variables, multiple linear regression analysis demonstrated that patients receiving continuous IV sedation had nearly twice the duration of mechanical ventilation compared with patients not receiving continuous IV sedation. Similarly, the adjusted ICU and hospital lengths of stay were statistically greater

Acknowledgments

The authors would like to thank Suzanne Ward, RN, for her assistance in formulating the study database.

References (36)

  • A controlled trial to improve care for terminally ill hospitalized adults

    JAMA

    (1995)
  • ShapiroBA et al.

    Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary: Society of Critical Care Medicine

    Crit Care Med

    (1995)
  • SearleNR et al.

    Propofol or midazolam for sedation and early extubation following cardiac surgery

    Can J Anaesth

    (1997)
  • ParkinsonL et al.

    A randomized trial of sedation in the critically ill

    Paediatr Anaesth

    (1997)
  • ChamorroC et al.

    Comparative study of propofol versus midazolam in the sedation of critically ill patients: results of a prospective, randomized, multicenter trial

    Crit Care Med

    (1996)
  • KongKL et al.

    Isoflurane compared with midazolam for sedation in the intensive care unit

    BMJ

    (1989)
  • BarkerDP et al.

    Stress, severity of illness, and outcome in ventilated preterm infants

    Arch Dis Childhood Fetal Neonatal Ed

    (1996)
  • BruderN et al.

    Energy expenditure and withdrawal of sedation in severe head-injured patients

    Crit Care Med

    (1994)
  • Cited by (0)

    The work was supported by a grant from the Barnes-Jewish Christian Innovation in Health Care Program.

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