The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit

Abstract

Objective: To examine the effect of an algorithm-based sedation guideline developed in a North American intensive care unit (ICU) on the duration of mechanical ventilation of patients in an Australian ICU.

Design and setting: The intervention was tested in a pre-intervention, post-intervention comparative investigation in a 14-bed adult intensive care unit.

Patients: Adult mechanically ventilated patients were selected consecutively (n=322). The pre-intervention and post-intervention groups were similar except for a higher number of patients with a neurological diagnosis in the pre-intervention group.

Intervention: An algorithm-based sedation guideline including a sedation scale was introduced using a multifaceted implementation strategy.

Measurements and results: The median duration of ventilation was 5.6 days in the post-intervention group, compared with 4.8 days for the pre-intervention group (P=0.99). The length of stay was 8.2 days in the post-intervention group versus 7.1 days in the pre-intervention group (P=0.04). There were no statistically significant differences for the other secondary outcomes, including the score on the Experience of Treatment in ICU 7 item questionnaire, number of tracheostomies and number of self-extubations. Records of compliance to recording the sedation score during both phases revealed that patients were slightly more deeply sedated when the guideline was used.

Conclusions: The use of the algorithm-based sedation guideline did not reduce duration of mechanical ventilation in the setting of this study.