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. 2018 Jan 13;10(1):e2062.
doi: 10.7759/cureus.2062.

The Effect of Daily Sedation-Weaning Application on Morbidity and Mortality in Intensive Care Unit Patients

Selcuk Kayir  1 , Hulya Ulusoy  2 , Guvenc Dogan  1
Affiliations

The Effect of Daily Sedation-Weaning Application on Morbidity and Mortality in Intensive Care Unit Patients

Selcuk Kayir et al. Cureus. .

Abstract

Background/aims Sedation is one of the most important components of intensive care unit (ICU) in patients who are mechanically ventilated at intensive care conditions. As a result of sedation and analgesia in the intensive care unit, the patient is to be awakened a comfortable and easy process. The aim of the study is to demonstrate the effects of day-time sedation interruptions in intensive care patients. Material and methods We made a retrospective review of 100 patients who were monitored, mechanically ventilated and treated at our intensive care unit between January 2008 and January 2013. Patients were divided into two groups, including Group P (continuous infusion of sedative agent) and Group D (daily sedation interruptions - daily recovery). Demographics, mechanical ventilation time, stay at intensive care unit, hospitalization period, time of first weaning, success of weaning, ventilator-related pneumonia (VRP), total doses of drugs, re-intubation frequency, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) scores and mortality rates of patients were compared. Ramsay Sedation Score (RSS) was used to evaluate the level of sedation. Considering that ideal sedation level is "3" with RSS, RSS < 3 is considered as mild sedation, while RSS > 3 is considered as deep sedation. Results There was no difference between demographics of patients. Mechanical ventilation period was significantly longer in Group P than Group D (p < 0.001). When stay at ICU unit was considered, ICU stay was significantly longer in Group P than Group D (p < 0.001). No statistically significant difference was found between two groups with respect to hospitalization period. In inter-group comparison, time to start first weaning was significantly late in Group P than Group D (p < 0.05). There was no difference between groups in terms of frequency of success of weaning and mortality rate (p > 0.05). In inter-group comparison the frequency of reintubation viewed in Group D was significantly less than in Group P (p < 0.05). Considering development of VRP, it was significantly more common in Group P in comparison with Group D (p < 0.05). No statistically significant difference was found between groups in terms of doses of sedative agents (p > 0.05). Considering doses of opioid analgesics, the total dose of fentanyl was significantly higher in Group P than Group D (p = 0.04), while no difference was found for doses of morphine (p > 0.05). Again, no statistical difference was found in doses of muscle relaxant agents (p > 0.05). Conclusion It was observed that the sedation technique with daily interruption is superior to continuous infusion of sedatives. Accordingly, we believe that daily weaning will make positive contributions to patients who are mechanically ventilated at intensive care unit.

Keywords: daily awakening; intensive care; sedation; weaning.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Scheme for spontaneous respiration attempt.
RSS: Ramsay Sedation Score; SRA: Spontaneous respiratory attempt.
Figure 2
Figure 2. Patient randomization scheme.
Figure 3
Figure 3. Mechanical ventilator, intensive care and hospital stay durations between the groups.
*:Statistically significant difference between groups (p < 0.001). ICU: Intensive care unit; MV: Mechanical ventilator.
Figure 4
Figure 4. Comparison of first weaning time between groups.
*: Statistically significant difference between the groups (p < 0.05).
Figure 5
Figure 5. Comparison of weaning success, reintubation, VRP and mortality between groups.
*= Statistical significance between groups (p < 0.05)​​​​​ VRP: Ventilator-related pneumonia.
Figure 6
Figure 6. Comparison of APACHE II scores between and within groups.
​​​​​* = Statistical significance between groups (p < 0.05) # = Statistical significance within group compared to 0 day (p < 0.05) APACHE II: Acute Physiology and Chronic Health Evaluation II.
Figure 7
Figure 7. Comparison of SOFA scores between and within groups.
* = Statistical significance between groups (p < 0.05) # = Statistical significance within group compared to 0 day (p < 0.05) SOFA: Sequential Organ Failure Assessment.
Figure 8
Figure 8. Comparison of total fentanyl doses consumed between groups.
* : Statistical significance between groups (p < 0.05).
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