Evaluation of a clinical pathway for sedation and analgesia of mechanically ventilated patients in a cardiac intensive care unit (CICU): The Brigham and Women's Hospital Levine CICU sedation pathways

European Heart Journal. Acute Cardiovascular Care
Aaron W AdayDavid A Morrow

Abstract

Intravenous sedation and analgesia are important therapies during mechanical ventilation (MV). However, daily interruption of these medications is associated with improved outcomes in mechanically ventilated patients. We tested a clinical pathway for the use of sedation and analgesia during MV in a cardiac intensive care unit (CICU). We evaluated all mechanically ventilated patients in a CICU during two phases: phase 1 prior to pathway implementation (PRE) and phase 2 post-pathway implementation (POST). A total of 198 patients (98 PRE and 100 POST) and 1012 days of intubation (574 PRE and 434 POST) were included in this analysis. We found an increase in the frequency of daily interruptions of sedation post-implementation (49.3% PRE and 58.4% POST, p=0.0041). There was a significant decrease in the mean duration of MV in the POST vs PRE periods (5.0±2.3 vs 6.1±2.8 days, p=0.015). There was also a significant decrease in total neuroimaging studies (9 vs 49, p=0.001) and a trend toward a decrease in tracheostomies (3.0% vs 6.1%, p=0.33). Mean CICU length of stay (LOS) and hospital LOS respectively were 10.4 days and 16.8 days PRE and 10.4 days and 17.9 days POST (p=0.99 and p=0.55). Mortality did not differ (PRE 36.7% vs POST 32.0...Continue Reading

References

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Citations

Feb 14, 2015·Journal of Evaluation in Clinical Practice·Petronella Bjurling-SjöbergInger Jansson
Jul 24, 2018·European Heart Journal. Acute Cardiovascular Care·Ryan A WatsonDavid A Morrow
Dec 5, 2019·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Sandeep DevabhakthuniMichael T Mccurdy
May 23, 2015·Journal of Physical Therapy Science·Christiane Riedi DanielJoão Afonso Ruaro
Nov 8, 2018·BMC Health Services Research·Petronella Bjurling-SjöbergLena Nordgren
Oct 25, 2017·European Heart Journal. Acute Cardiovascular Care·Sammy ZakariaNisha Chandra-Strobos
Oct 30, 2020·Circulation·Christopher B FordyceUNKNOWN American Heart Association Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Cou
Nov 26, 2020·Critical Care Explorations·Thomas S MetkusDavid A Morrow
May 14, 2021·Heliyon·Petronella Bjurling-SjöbergLena Nordgren

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Methods Mentioned

BETA
sedation

Software Mentioned

GraphPad
Pathway

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