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American Journal of Critical Care. 2008;17: 349-356
Copyright © 2008 by the American Association of Critical-Care Nurses.
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Duration of Mechanical Ventilation in an Adult Intensive Care Unit After Introduction of Sedation and Pain Scales

By Teresa Ann Williams, M HlthSci PG Dip Clin Epi, BN, Suzanne Martin, BSci (Nsg), Gavin Leslie, PhD, BAppSc, Linda Thomas, BSci (Nsg), Timothy Leen, BSci (Nsg), Sheralee Tamaliunas, BSci (Nsg), K. Y. Lee, MBBS and Geoffrey Dobb, MBBS, FFICANZCA, FJFICM. Teresa Ann Williams is a nurse researcher, Suzanne Martin is a clinical nurse specialist, Linda Thomas is a research coordinator/clinical nurse, Timothy Leen is a clinical nurse specialist, Sheralee Tamaliunas is a clinical nurse specialist, and K. Y. Lee is an intensive care specialist in the intensive care unit at Royal Perth Hospital, Perth, Western Australia. Gavin Leslie is an associate professor and has a joint appointment in critical care nursing at Royal Perth Hospital and Curtin University of Technology, Perth, Australia. Geoffrey Dobb is head of the intensive care unit at Royal Perth Hospital and a clinical associate professor in the School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.

Corresponding author: Teresa Williams, ICU, Royal Perth Hospital, Wellington St, Royal Perth Hospital, Western Australia 6000 (e-mail: teresa.williams{at}health.wa.gov.au).

Background Sedation and analgesia scales promote a less-distressing experience in the intensive care unit and minimize complications for patients receiving mechanical ventilation.

Objectives To evaluate outcomes before and after introduction of scales for sedation and analgesia in a general intensive care unit.

Method A before-and-after design was used to evaluate introduction of the Richmond Agitation-Sedation Scale and the Behavioral Pain Scale for patients receiving mechanical ventilation. Data were collected for 6 months before and 6 months after training in and introduction of the scales.

Results A total of 769 patients received mechanical ventilation for at least 6 hours (369 patients before and 400 patients after implementation). Age, scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II, and diagnostic groups were similar in the 2 groups, but the after group had more men than did the before group. Duration of mechanical ventilation did not change significantly after the scales were introduced (median, 24 vs 28 hours). For patients who received mechanical ventilation for 96 hours or longer (24%), mechanical ventilation lasted longer after implementation of the scales (P =.03). Length of stay in the intensive care unit was similar in the 2 groups (P = .18), but patients received sedatives for longer after implementation (P=.01). By logistic regression analysis, APACHE II score (P <.001) and diagnostic group (P <.001) were independent predictors of mechanical ventilation lasting 96 hours or longer.

Conclusion Sedation and analgesia scales did not reduce duration of ventilation in an Australian intensive care unit.


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