Protocolized Sedation is Recommended Over Usual Care for Mechanical Ventilation

by Joseph Esherick, M.D., FAAFP, FHM

A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effects of protocolized sedation in mechanically ventilated adult intensive care unit patients. Six randomized controlled trials and 1243 patients were studied. The results showed that protocolized sedation compared with usual care led to decreased mortality (RR = 0.85), decreased ICU length of stay (-1.8 days), decreased hospital length of stay (-3.5 days), decreased tracheostomy rates (RR = 0.69), and no difference in ventilator days, reintubation rates, or self-extubation rates. Overall, there are many advantages to protocolized sedation.

 

Another study aimed to determine the effectiveness of implementing a “Wake-up and Breath Protocol” on sedation and delirium in the ICU. 702 consecutive ICU patients who were mechanically ventilated were observed from 2010 to 2013. Compared with usual care, the “Wake-up and Breath Protocol” led to an increased Richmond Agitation Sedation Scale (RASS) score of 1, an unchanged incidence of ICU delirium, and a decrease in combined delirium/coma rate from 91% to 85%.

 

 

 

Minhas MA, et al. Effect of Protocolized Sedation on Clinical Outcomes in Mechanically Ventilated Intensive Care Unit Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Mayo Clin Proc. 2015 May; 90 (5): 613-23.

 

Khan BA, et al. Effectiveness of implementing a wake up and breathe program on sedation and delirium in the ICU. Crit Care Med. 2014 Dec; 42 (12):e791-5.