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Randomized trial comparing daily interruption of sedation and nursing-implemented sedation algorithm in medical intensive care unit patients.

de Wit M, Gennings C, Jenvey WI, Epstein SK - Crit Care (2008)

Bottom Line: The Data Safety Monitoring Board convened after DIS patients were found to have higher hospital mortality; however, no causal connection between DIS and increased mortality was identified.In our cohort of patients, the use of SA was associated with reduced duration of MV and lengths of stay compared with DIS.Based on these results, DIS may not be appropriate in all mechanically ventilated patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pulmonary and Critical Care Division, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, PO Box 980050, Richmond, VA 23298-0050, USA. mdewit@mcvh-vcu.edu

ABSTRACT

Introduction: Daily interruption of sedation (DIS) and sedation algorithms (SAs) have been shown to decrease mechanical ventilation (MV) duration. We conducted a randomized study comparing these strategies.

Methods: Mechanically ventilated adults 18 years old or older in the medical intensive care unit (ICU) were randomly assigned to DIS or SA. Exclusion criteria were severe neurocognitive dysfunction, administration of neuromuscular blockers, and tracheostomy. Study endpoints were total MV duration and 28-day ventilator-free survival.

Results: The study was terminated prematurely after 74 patients were enrolled (DIS 36 and SA 38). The two groups had similar age, gender, racial distribution, Acute Physiology and Chronic Health Evaluation II score, and reason for MV. The Data Safety Monitoring Board convened after DIS patients were found to have higher hospital mortality; however, no causal connection between DIS and increased mortality was identified. Interim analysis demonstrated a significant difference in primary endpoint, and study termination was recommended. The DIS group had longer total duration of MV (median 6.7 versus 3.9 days; P = 0.0003), slower improvement of Sequential Organ Failure Assessment over time (0.70 versus 0.23 units per day; P = 0.025), longer ICU length of stay (15 versus 8 days; P < 0.0001), and longer hospital length of stay (23 versus 12 days; P = 0.01).

Conclusion: In our cohort of patients, the use of SA was associated with reduced duration of MV and lengths of stay compared with DIS. Based on these results, DIS may not be appropriate in all mechanically ventilated patients.

Trial registration: ClinicalTrials.gov NCT00205517.

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Related in: MedlinePlus

Kaplan-Meier survival curve of total duration of mechanical ventilation (MV) for patients treated by daily interruption of sedation (thick line) and sedation algorithm (thin line) (P = 0.0003).
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Figure 2: Kaplan-Meier survival curve of total duration of mechanical ventilation (MV) for patients treated by daily interruption of sedation (thick line) and sedation algorithm (thin line) (P = 0.0003).

Mentions: The time to successful extubation from MV was 4.0 days longer in the DIS group (median 8.1 days, 95% CI 4.1, undeterminable days for DIS versus 4.1 days, 95% CI 3.0, 4.9 days for SA). The total duration of MV was 2.8 days longer for the DIS group (Table 3). A Kaplan-Meier analysis graphing the total duration of MV shows that the probability of remaining on MV was reduced in the SA group (Figure 2). The 28-day ventilator-free survival was 7 days longer in the SA group compared with the DIS group (P = 0.004) (Table 3). Both the ICU and hospital lengths of stay were longer for DIS patients (Table 3).


Randomized trial comparing daily interruption of sedation and nursing-implemented sedation algorithm in medical intensive care unit patients.

de Wit M, Gennings C, Jenvey WI, Epstein SK - Crit Care (2008)

Kaplan-Meier survival curve of total duration of mechanical ventilation (MV) for patients treated by daily interruption of sedation (thick line) and sedation algorithm (thin line) (P = 0.0003).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2481461&req=5

Figure 2: Kaplan-Meier survival curve of total duration of mechanical ventilation (MV) for patients treated by daily interruption of sedation (thick line) and sedation algorithm (thin line) (P = 0.0003).
Mentions: The time to successful extubation from MV was 4.0 days longer in the DIS group (median 8.1 days, 95% CI 4.1, undeterminable days for DIS versus 4.1 days, 95% CI 3.0, 4.9 days for SA). The total duration of MV was 2.8 days longer for the DIS group (Table 3). A Kaplan-Meier analysis graphing the total duration of MV shows that the probability of remaining on MV was reduced in the SA group (Figure 2). The 28-day ventilator-free survival was 7 days longer in the SA group compared with the DIS group (P = 0.004) (Table 3). Both the ICU and hospital lengths of stay were longer for DIS patients (Table 3).

Bottom Line: The Data Safety Monitoring Board convened after DIS patients were found to have higher hospital mortality; however, no causal connection between DIS and increased mortality was identified.In our cohort of patients, the use of SA was associated with reduced duration of MV and lengths of stay compared with DIS.Based on these results, DIS may not be appropriate in all mechanically ventilated patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Pulmonary and Critical Care Division, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, PO Box 980050, Richmond, VA 23298-0050, USA. mdewit@mcvh-vcu.edu

ABSTRACT

Introduction: Daily interruption of sedation (DIS) and sedation algorithms (SAs) have been shown to decrease mechanical ventilation (MV) duration. We conducted a randomized study comparing these strategies.

Methods: Mechanically ventilated adults 18 years old or older in the medical intensive care unit (ICU) were randomly assigned to DIS or SA. Exclusion criteria were severe neurocognitive dysfunction, administration of neuromuscular blockers, and tracheostomy. Study endpoints were total MV duration and 28-day ventilator-free survival.

Results: The study was terminated prematurely after 74 patients were enrolled (DIS 36 and SA 38). The two groups had similar age, gender, racial distribution, Acute Physiology and Chronic Health Evaluation II score, and reason for MV. The Data Safety Monitoring Board convened after DIS patients were found to have higher hospital mortality; however, no causal connection between DIS and increased mortality was identified. Interim analysis demonstrated a significant difference in primary endpoint, and study termination was recommended. The DIS group had longer total duration of MV (median 6.7 versus 3.9 days; P = 0.0003), slower improvement of Sequential Organ Failure Assessment over time (0.70 versus 0.23 units per day; P = 0.025), longer ICU length of stay (15 versus 8 days; P < 0.0001), and longer hospital length of stay (23 versus 12 days; P = 0.01).

Conclusion: In our cohort of patients, the use of SA was associated with reduced duration of MV and lengths of stay compared with DIS. Based on these results, DIS may not be appropriate in all mechanically ventilated patients.

Trial registration: ClinicalTrials.gov NCT00205517.

Show MeSH
Related in: MedlinePlus