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Effect of a nursing-implemented sedation protocol on weaning outcome*

Arias-Rivera, Susana RN; del Mar Sánchez-Sánchez, Maria RN; Santos-Díaz, Rosa RN; Gallardo-Murillo, Juana RN; Sánchez-Izquierdo, Raquel RN; Frutos-Vivar, Fernando MD; Ferguson, Niall D. MD, MSc; Esteban, Andrés MD, PhD

doi: 10.1097/CCM.0b013e31817bfd60
Clinical Investigations

Objective: To evaluate the effect of the implementation of a nursing-driven protocol of sedation on duration of intubation.

Design: Before-and-after prospective study.

Setting: 18-bed medical-surgical intensive care unit.

Patients: Patients receiving mechanical ventilation longer than 48 hrs who were ready to wean.

Interventions: During the observational period, sedatives and analgesics were adjusted according to physicians’ orders. During the intervention period, sedatives and analgesics were adjusted by nurses according to an algorithm-based sedation guideline, including a sedation scale.

Measurements and Main Results: A total of 356 patients were included in the study (176 patients in the observational period and 189 patients in the intervention period). There were no significant differences in the duration of intubation between the two periods (median, 7 [interquartile range, 5–13] days vs. 7 [interquartile range, 5–9] days). In a Kaplan-Meier analysis, the probability of successful extubation was higher during the intervention period than during the observational period (log-rank = 0.02). During the intervention period, patients were more awake without a significant increment in the nurse workload; however, there was no significant decrease in the total doses of sedatives and analgesics administered.

Conclusions: The implementation of a nursing-driven protocol of sedation may improve the probability of successful extubation in a heterogeneous population of mechanically ventilated patients.

From the Intensive Care Unit & Burn Unit, Hospital Universitario de Getafe; Madrid, Spain and CIBER Enfermedades Respiratorias (SAR, MSS, RSD, JGM, RSI, FFV, AE); and Interdepartmental Division of Critical Care Medicine, and Department of Medicine, Division of Respirology (NDF), University Health Network, University of Toronto, Toronto, Canada.

Supported, in part, by grant 03/1177 of Fondo de Investigaciones Sanitarias, Red GIRA (G03/063) and Red RESPIRA (C03/11) from Instituto de Salud Carlos III, Spain.

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© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins