| Title |
Clinical effectiveness of a sedation protocol minimizing benzodiazepine infusions and favoring early dexmedetomidine: a before-after study
|
|---|---|
| Published in |
Critical Care, December 2015
|
| DOI | 10.1186/s13054-015-0874-0 |
| Pubmed ID | |
| Authors |
Lee P Skrupky, Anne M Drewry, Brian Wessman, R Ryan Field, Richard E Fagley, Linda Varghese, Angela Lieu, Joshua Olatunde, Scott T Micek, Marin H Kollef, Walter A Boyle |
| Abstract |
Randomized controlled trials suggest clinical outcomes may be improved with dexmedetomidine as compared to benzodiazepines, however further study and validation is needed. The objective of this study was to determine the clinical effectiveness of a sedation protocol minimizing benzodiazepine use in favor of early dexmedetomidine. This was a before-after study including adult surgical and medical ICU patients requiring mechanical ventilation and continuous sedation for at least 24 hours. The before phase included consecutive patients admitted between April 1 and August 31, 2011. Subsequently, the protocol was modified to minimize use of benzodiazepines in favor of early dexmedetomidine through a multidisciplinary approach and staff education was provided. The after phase included consecutive eligible patients between May 1 and October 31, 2012. 199 patients were included, with 97 patients in the before and 102 in the after phase. Baseline characteristics were well balanced between groups. Use of midazolam as initial sedation (58% vs. 27%, p < 0.0001) or at any point during the ICU stay (76% vs. 48%, p < 0.0001) was significantly reduced in the after phase. Dexmedetomidine use as initial sedation (2% vs. 39%, p < 0.0001) or at any point during the ICU stay (39% vs. 82%, p < 0.0001) significantly increased. Both the prevalence (81% vs. 93%, p =0.013) and median percent of days with delirium (55% (IQR 18-83) vs. 71% (IQR 45-100), p = 0.001) were increased in the after phase. The median duration of mechanical ventilation was significantly reduced in the after phase (110 (IQR 59-192) vs. 74.5 (IQR 42-148) hrs, p = 0.029) and significantly fewer patients required tracheostomy (20% vs. 9%, p = 0.040). The median ICU length of stay was 8 (IQR 4-12) days in the before phase and 6 (IQR 3-11) days in the after phase (p = 0.252). Implementing a sedation protocol that targeted light sedation and reduced benzodiazepine use led to significant improvements in the duration of mechanical ventilation and requirement for tracheostomy despite increases in the prevalence and duration of ICU delirium. |
X Demographics
The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 109 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 3 | 3% |
| United Kingdom | 1 | <1% |
| Italy | 1 | <1% |
| Brazil | 1 | <1% |
| Unknown | 103 | 94% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 17 | 16% |
| Student > Bachelor | 17 | 16% |
| Researcher | 13 | 12% |
| Student > Ph. D. Student | 9 | 8% |
| Other | 8 | 7% |
| Other | 24 | 22% |
| Unknown | 21 | 19% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 43 | 39% |
| Nursing and Health Professions | 19 | 17% |
| Pharmacology, Toxicology and Pharmaceutical Science | 4 | 4% |
| Psychology | 3 | 3% |
| Social Sciences | 3 | 3% |
| Other | 8 | 7% |
| Unknown | 29 | 27% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 April 2015.
All research outputs
#17,286,379
of 25,374,647 outputs
Outputs from Critical Care
#5,469
of 6,554 outputs
Outputs of similar age
#239,675
of 395,421 outputs
Outputs of similar age from Critical Care
#455
of 466 outputs
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