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Impact of an Analgesia-Based Sedation Protocol on Mechanically Ventilated Patients in a Medical Intensive Care Unit

Faust, Andrew C. PharmD, BCPS; Rajan, Pearl PharmD, BCPS; Sheperd, Lyndsay A. PharmD, BCPS; Alvarez, Carlos A. PharmD, MSc, MSCS, BCPS; McCorstin, Phyllis APRN, CNS; Doebele, Rebecca L. MD

doi: 10.1213/ANE.0000000000001393
Critical Care and Resuscitation: Original Clinical Research Report

BACKGROUND: Recent attention to adverse effects of intensive care unit (ICU) sedation has led to the use of strategies that target a “lighter” depth of sedation. Among these strategies are “analgosedation” protocols, which prioritize pain management and preferentially use IV opioids before administration of continuously infused sedatives such as propofol or midazolam. We hypothesized that using an analgosedation protocol would result in a shorter duration of mechanical ventilation than a protocol with greater emphasis on IV sedatives

METHODS: We conducted a retrospective study comparing the duration of mechanical ventilation before and after implementation of an analgosedation protocol in a 24-bed medical ICU. Patients were aged 18 years or older and required mechanical ventilation where a light level of sedation was clinically appropriate. Exclusion criteria included a clinical need for deeper levels of sedation or tracheal intubation confined to the perioperative period.

RESULTS: Seventy-nine patients were included in the postimplementation group and 65 in the preimplementation group. After adjustment for baseline covariates, introduction of the 2013 analgosedation protocol was associated with a decreased duration of mechanical ventilation (−26.62 hours; 95% confidence interval, − 44.98 to −8.26, P = 0.005). Patients managed with the analgosedation protocol experienced a lighter level of sedation (median Richmond Agitation-Sedation Scale, −2.57 vs −1.25, P = 0.001) and improved pain management (median Critical-Care Pain Observation Tool score, 2.0 vs 1.5, P = 0.03). The use of continuously infused sedatives was reduced by 54.3% (92.3% vs 38.0%, P < 0.001).

CONCLUSIONS: Our findings suggest that implementation of an analgosedation protocol was associated with an overall lighter level of sedation, shorter mean ventilator duration, and a reduced use of continuous infusion sedatives. Further studies are needed to assess the impact of such protocols on ICU delirium.

Supplemental Digital Content is available in the text.Published ahead of print August 1, 2016.

From the *Department of Pharmacy, Texas Health Resources Presbyterian Hospital of Dallas, Dallas, Texas; Texas Tech University Health Sciences Center, College of Pharmacy, Dallas, Texas; Department of Pulmonary and Critical Care Medicine, Texas Health Resources Presbyterian Hospital of Dallas, Dallas, Texas; and §Southwest Pulmonary Associates, Dallas, Texas.

Published ahead of print August 1, 2016.

Accepted for publication March 30, 2016.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Andrew C. Faust, PharmD, BCPS, Texas Health Presbyterian Hospital Dallas, 8200 Walnut Hill Ln, Dallas, TX 75231. Address e-mail to andrewfaust@texashealth.org.

© 2016 International Anesthesia Research Society