SEDATION PRACTICES AND CLINICAL OUTCOMES IN MECHANICALLY VENTILATED PATIENTS: A PROSPECTIVE OBSERVATIONAL STUDY FROM A TERTIARY CARE HOSPITAL
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Keywords
Mechanical ventilation; ICU sedation; Midazolam; Delirium; RASS; Critical care; Tertiary care hospital
Abstract
Background: Sedation is a critical component of care in mechanically ventilated patients; however, inappropriate sedation practices may adversely affect clinical outcomes. There is limited prospective data from Indian tertiary care ICUs evaluating sedation patterns and associated outcomes.
Objectives: To assess sedation practices and evaluate clinical outcomes among mechanically ventilated patients in a tertiary care hospital.
Methods: A prospective observational study was conducted in the ICU of a tertiary care hospital from April 2020 to October 2020. A total of 48 adult patients requiring mechanical ventilation for more than 24 hours were included using consecutive sampling. Data regarding sedation practices, including sedative agents and depth of sedation assessed by the Richmond Agitation-Sedation Scale (RASS), were recorded. Outcomes assessed included duration of mechanical ventilation, ICU length of stay, incidence of delirium, self-extubation, and mortality. Statistical analysis was performed using SPSS version 25, with p<0.05 considered statistically significant.
Results: Midazolam was the most commonly used sedative agent (54.2%), followed by propofol (29.2%) and dexmedetomidine (16.7%). A majority of patients were maintained under moderate to deep sedation levels. The mean duration of mechanical ventilation was 7.8 ± 3.2 days, and ICU stay was 10.6 ± 4.5 days. Delirium occurred in 25% of patients, while mortality was 16.7%. Deeper sedation was associated with prolonged ventilation and higher ICU stay.
Conclusion: Sedation practices in the studied ICU were predominantly benzodiazepine-based with a tendency toward deeper sedation levels, which were associated with less favorable clinical outcomes. Standardized sedation protocols emphasizing lighter sedation and routine monitoring may improve outcomes in mechanically ventilated patients.
References
2. Kitterer D, Schwab M, Alscher MD, Braun N, Latus J. Drug-induced acid-base disorders. Pediatric nephrology. 2015 Sep;30(9):1407-23.
3. Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, McArthur C, Seppelt IM, Webb S, Weisbrodt L. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. American journal of respiratory and critical care medicine. 2012 Oct;186(8):724-31.
4. Kress JP, Hall JB. Sedation in the mechanically ventilated patient. Critical care medicine. 2006 Oct 1;34(10):2541-6.
5. Pisani MA, Devlin JW, Skrobik Y. Pain and delirium in critical illness: an exploration of key 2018 SCCM PADIS guideline evidence gaps. InSeminars in respiratory and critical care medicine 2019 Oct (Vol. 40, No. 05, pp. 604-613). Thieme Medical Publishers.
6. Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, Bratty JR, Takala J, Dexmedetomidine for Long-Term Sedation Investigators. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. Jama. 2012 Mar 21;307(11):1151-60.
7. Chawla R, Myatra SN, Ramakrishnan N, Todi S, Kansal S, Dash SK. Current practices of mobilization, analgesia, relaxants and sedation in Indian ICUs: A survey conducted by the Indian Society of Critical Care Medicine. Indian J Crit Care Med. 2014 Sep;18(9):575-84
8. Gunaydin DU, Kurtipek O. Pre-Operative Evaluation of Adults Undergoing Elective Noncardiac Surgery: Summary of the Updated Guideline From the European Society of Anaesthesiology. TURKISH JOURNAL OF ANAESTHESIOLOGY AND REANIMATION. 2019;47(3).
9. Geocadin RG, Callaway CW, Fink EL, Golan E, Greer DM, Ko NU, Lang E, Licht DJ, Marino BS, McNair ND, Peberdy MA. Standards for studies of neurological prognostication in comatose survivors of cardiac arrest: a scientific statement from the American Heart Association. Circulation. 2019 Aug 27;140(9):e517-42.
10. Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). Jama. 2001 Dec 5;286(21):2703-10.
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Dr. Rajesh Garg
Associate Professor, Department of Anaesthesiology, IQ City Medical College, Durgapur, West Bengal, India. (
Dr. Gautam Bhardwaj
Associate Professor, Department of Anaesthesiology, ICare Institute of Medical Sciences & Research, Haldia, West Bengal, India.
Dr. Jyoti Mala
Assistant Professor, Department of Anaesthesiology, Netaji Subhas Medical College & Hospital, Bihta, Patna, Bihar, India.(
