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Open Access 01-12-2016 | Research

Variation in diurnal sedation in mechanically ventilated patients who are managed with a sedation protocol alone or a sedation protocol and daily interruption

Authors: Sangeeta Mehta, Maureen Meade, Lisa Burry, Ranjeeta Mallick, Christina Katsios, Dean Fergusson, Peter Dodek, Karen Burns, Margaret Herridge, John W. Devlin, Maged Tanios, Robert Fowler, Michael Jacka, Yoanna Skrobik, Kendiss Olafson, Deborah Cook, for the SLEAP Investigators and the Canadian Critical Care Trials Group

Published in: Critical Care | Issue 1/2016

Abstract

Background

Mechanically ventilated patients may receive more sedation during the night than during the day, potentially delaying extubation. We compared nighttime and daytime benzodiazepine and opioid administration in adult patients enrolled in a multicenter sedation trial comparing protocolized sedation alone or protocolized sedation combined with daily sedation interruption; and we evaluated whether nighttime and daytime doses were associated with liberation from mechanical ventilation.

Methods

This is a secondary analysis of a randomized trial which was conducted in 16 North American medical-surgical ICUs. In all 423 patients, nurses applied a validated sedation scale hourly to titrate benzodiazepine and opioid infusions to achieve a light level of sedation. Using fentanyl equivalents and midazolam equivalents, we compared dosages administered during night (19:00 to 07:00) and day (07:00 to 19:00) shifts. Using multivariable logistic regression we evaluated the association between nighttime and daytime opioid and sedative doses, and spontaneous breathing trial (SBT) conduct, SBT success, and extubation.

Results

Nighttime benzodiazepine and opioid doses were significantly higher than daytime doses (mean difference midazolam equivalents 23.3 mg, 95 % CI 12.9, 33.8, p < 0.0001; mean difference fentanyl equivalents 356 mcg, 95 % CI 130, 582, p = 0.0021). Mean Sedation Agitation Scale score was similar between night and day, and was at target (3.2 vs 3.3, 95 % CI −0.05, 0.02, p = 0.35). Self-reported nurse workload was similar during the night and day. Patients were more often restrained during day shifts (76.3 % vs 73.7 %, p < 0.0001), and there were more unintentional device removals during the day compared with night (15.9 % vs 9.1 %, p < 0.0001). Increases in nighttime drug doses were independently associated with failure to meet SBT screening criteria, SBT failure, and the decision not to extubate the patient despite successful SBT.

Conclusion

Patients received higher doses of opioids and benzodiazepines at night. Higher nighttime doses were associated with SBT failure and delayed extubation.

Trial registration

ClinicalTrials.gov NCT00675363. Registered 7 May 2008.

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Title: Variation in diurnal sedation in mechanically ventilated patients who are managed with a sedation protocol alone or a sedation protocol and daily interruption
Authors: Sangeeta Mehta
Maureen Meade
Lisa Burry
Ranjeeta Mallick
Christina Katsios
Dean Fergusson
Peter Dodek
Karen Burns
Margaret Herridge
John W. Devlin
Maged Tanios
Robert Fowler
Michael Jacka
Yoanna Skrobik
Kendiss Olafson
Deborah Cook
for the SLEAP Investigators and the Canadian Critical Care Trials Group
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-016-1405-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Variation in diurnal sedation in mechanically ventilated patients who are managed with a sedation protocol alone or a sedation protocol and daily interruption

Abstract

Background

Methods

Results

Conclusion

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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