Evaluación de una guía local de sedación en la unidad de cuidados intensivos dirigidos a un objetivo de la administración de sedantes y analgésicos

Evaluación de una guía local de sedación en la unidad de cuidados intensivos dirigidos a un objetivo de la administración de sedantes y analgésicos Evaluation of a local ICU sedation guideline on goal-directed administration of sedatives and analgesics Jeremy R DeGrado, Kevin E Anger, Paul M Szumita, Carol D Pierce, Anthony F Massaro Department of Pharmacy, Department of Nursing, Department of Pulmonary Medicine, Brigham and Women's Hospital, Boston, MA, USA Journal of Pain Research Published Date May 2011 Volume 2011:4 Pages 127 - 134 DOI: http://dx.doi.org/10.2147/JPR.S18161 Purpose: Sedatives and analgesics are commonly used in mechanically ventilated patients in the intensive care unit. Sedation guidelines have been shown to improve sedation management as well as various patient outcomes. The main objective was to evaluate adherence to a sedation guideline with both sedative prescribing and documentation of Richmond Agitation-Sedation Scale (RASS) scores. Methods: In a retrospective chart review, data was collected on 111 medical intensive care unit patients mechanically ventilated via endotracheal tube for 12 hours or greater at Brigham and Women's Hospital. Fifty-seven patients were evaluated pre-guideline implementation and 54 patients were evaluated post-guideline. Results: Significant increases were seen in the post-guideline group in goal-directed sedation with a patient-specific RASS goal in the sedation order: 21.3 vs 85.4% (P < 0.001), and mean number of sedation assessments per 24 hours using the RASS: 4.7 vs 11.4 (P < 0.001). Similarly, this group experienced a higher percentage of RASS scores at their sedation goal: 31.4 vs 44.1% (P < 0.001). No difference was seen in other clinical endpoints. Conclusion: Implementation and routine application of a hospital pain and sedation guideline was associated with significantly improved sedation metrics, such as goal-directed sedation, as well as frequency of sedation level assessment and documentation. An increase was observed in the time that post-guideline patients spent at or near their RASS goal. Keywords: sedation, agitation, guideline, RASS, mechanically ventilated, intensive care unit http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100227/pdf/jpr-4-127.pdf

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