The Significance of Sedation Control in Patients Receiving Mechanical Ventilation.
10.4046/trd.2012.73.3.151
- Author:
Yun Jung JUNG
1
;
Wou Young CHUNG
;
Miyeon LEE
;
Keu Sung LEE
;
Joo Hun PARK
;
Seung Soo SHEEN
;
Sung Chul HWANG
;
Kwang Joo PARK
Author Information
1. Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea. parkkj@ajou.ac.kr
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Conscious Sedation;
Ventilators, Mechanical;
Hypnotics and Sedatives;
Consciousness Monitors
- MeSH:
Conscious Sedation;
Consciousness Monitors;
Electrocardiography;
Hemodynamics;
Humans;
Hypnotics and Sedatives;
Lung Diseases;
Midazolam;
Prospective Studies;
Respiration, Artificial;
Ventilators, Mechanical;
Weights and Measures
- From:Tuberculosis and Respiratory Diseases
2012;73(3):151-161
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation. METHODS: A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS) was conducted in the SAG. RESULTS: In the SAG, the dose of midazolam was significantly reduced by control of sedation (day 1, 1.3+/-0.5 microg/kg/min; day 2, 0.9+/-0.4 microg/kg/min; p<0.01), and was significantly lower than the ECG on day 2 (p<0.01). Likewise, on day 2, sedation levels were significantly lower in the SAG than in the ECG. Significant relationship was found between Ramsay sedation scale and Richmond agitation-sedation scale (RASS; rs=-0.57), Ramsay Sedation Scale and Bispectral Index (BIS; rs=0.77), and RASS and BIS (rs=-0.79). In 10 patients, who didn't require re-sedation after DIS, BIS showed the earliest and most significant changes among the sedation scales. Ventilatory parameters showed significant but less prominent changes, and hemodynamic parameters didn't show significant changes. No seriously adverse events ensued after the implementation of DIS. CONCLUSION: Active assessment and control of sedation significantly reduced the dosage of sedatives in patients receiving mechanical ventilation. DIS, conducted in limited cases, suggested its potential efficacy and tolerability.
