Daily Interruption of Sedation

Daily Interruption of Sedation



Abstract

Recent epidemiological studies have identified a high prevalence of sedation in the intensive care unit (ICU). The practice of DIS, which is the retention of all sedative and analgesic drugs until patients are awake on a daily basis, you can limit excessive sedation. DIS has been shown to reduce the duration of mechanical ventilation and length of ICU stay, reducing the number of neurodiagnostic tests to assess changes in mental status, decreased frequency of complications associated with critical illness, and reduce the dose total of benzodiazepines and opioids administered.

Although recent studies support the use of the DIS, it remains underutilized in clinical practice and further testing may be necessary before this intervention will gain widespread acceptance. Barriers to the use of DIS are the lack of acceptance of nursing and concerns regarding the removal of invasive devices in patients, patient discomfort, respiratory compromise, and withdrawal syndromes. Some doctors also are concerned about the possibility of long-term psychological consequences and the risk of myocardial ischemia during DIS in patients with coronary risk factors.

Daily interruption of sedation

Introduction

Pain and anxiety are frequently observed in patients requiring mechanical ventilation and administration of analgesics and sedatives are often medically NECESSARY. Inadequate sedation may lead to the elimination of patients with invasive devices or ventilator dyssynchrony criteria, increased oxygen consumption, or unpleasant memories. While it is important that patients comfortable and provide relief of anxiety, sedation should be avoided because it is associated with an increased duration of mechanical ventilation and intensive care unit (ICU), length of stay. The Society of Critical Care Medicine pain and sedation guidelines published in 2002 recommended that an objective of sedation should be set for each patient, and this is usually a calm patient that can be easily awakened (Watling, 2008, 66).

Recent epidemiological studies, however, have identified a high prevalence of sedation in ICU. A recent observational study found that only 43% of patients on day 2 of ICU stay and 31% of patients in the ICU six days his level of sedation was measured with a tool standardized assessment of these patients, a deep state of sedation (i.e., a score of sedation-agitation scale of 1 or 2) was observed in 57% of patients in the ICU day 2 and 41% of patients on the day of the UCI 6. Moreover, a cohort study found that patients were not awake or minimally waking in 32% of the assessments of sedation, but only 2. % of nursing assessments for patients considered to be over sedated.

Several strategies can help limit excessive sedation and has been shown to reduce the duration of mechanical ventilation in critically ill patients. Examples include the use of sedation protocol led directly iv push (or bolus) of benzodiazepines instead of a continuous infusion sedation with a short duration of action (e.g., dexmedetomidine propofol), and disruption Daily sedation (DIS), also referred to as spontaneous awakening trials, where all sedative drugs and analgesics are stopped until the patient is awake on a daily ...