Dr WAN Wing Lun
Abstract
Sedation therapy is perhaps the most common medical therapy prescribed for critically ill
patients and it remains a challenging and contentious practice area in intensive care. Inappropriate use will lead to serious consequences. In the critically ill, the pharmacokinetic and pharmacodynamic changes after sedative administration can be highly variable and unpredictable. Moreover the sedative needs of a patient will change with time during the disease course. Hence it is important to assess the level of sedation frequently and titrate the sedative dose accordingly i.e. an individualized approach to sedation therapy.
We designed a sedation protocol that was implemented by nurses for use in adult ICU patients requiring mechanical ventilation. The effectiveness of the protocol was evaluated by a prospective study performed in May to September 2000 in the ICU of Princess Margaret Hospital. Data collected from 58 patients were analyzed. There was a significant reduction in the duration of continuous intravenous sedation, ventilator time (in medical patients) after protocol implementation (n = 28, protocol group) when compared with a historical control group (n = 30) receiving conventional non-protocol-directed sedation. There was an associated reduction in the use of sedatives and analgesics during the study period. In addition, early weaning using pressure support ventilation was facilitated.
We demonstrated that a nursing-implemented protocolized approach to sedation therapy is feasible and safe in our local ICU setting. It’s also shown that sedation assessment by even a simple scale could provide us clinically important information for adjustment of the sedative dose. Follow up study on the patients’ experience of the quality of sedation is useful for further evaluation of this approach to sedation therapy.