Tuberc Respir Dis.  2012 Sep;73(3):151-161. 10.4046/trd.2012.73.3.151.

The Significance of Sedation Control in Patients Receiving Mechanical Ventilation

• Jung YJ
• Chung WY
• Lee M
• Lee KS
• Park JH
• Sheen SS
• Hwang SC
• Park KJ

• KMID: 1842910
• DOI: http://doi.org/10.4046/trd.2012.73.3.151

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.

Keyword

Conscious Sedation; Ventilators, Mechanical; Hypnotics and Sedatives; Consciousness Monitors

MeSH Terms

Conscious Sedation
Consciousness Monitors
Electrocardiography
Hemodynamics
Humans
Hypnotics and Sedatives
Lung Diseases
Midazolam
Prospective Studies
Respiration, Artificial
Ventilators, Mechanical
Weights and Measures
Hypnotics and Sedatives
Midazolam

Figure

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  Figure 1 Patient enrollment, randomization, and management flow.

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  Figure 2 Sedation control protocol in the sedation assessment group. RASS: Richmond agitation-sedation scale.

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  Figure 3 Comparison of intravenous midazolam doses on day 1 and 2 between the sedation assessment group and empiric control group. Data are expressed as the mean±SEM. *p<0.01 compared to both sedation assessment group on day 1 and empiric control group on day 2.

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  Figure 4 Correlations among sedation scales in all patients. Spearman's correlation coefficients were computed between Ramsay sedation scale and Richmond agitation-sedation scale (RASS; A), Ramsay sedation scale and Bispectral index (BIS; B), and RASS and BIS (C).

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  Figure 5 Changes in sedation scales after the implementation of daily interruption of sedation (DIS) in the sedation assessment group. (A) Ramsay sedation scale, (B) RASS, (C) BIS score. Data are expressed as the mean±SEM. *p<0.05 and †p<0.01 according to Friedman test. RASS: Richmond agitation-sedation scale; BIS: Bispectral index.

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  Figure 6 Changes in ventilator parameters after the implementation of daily interruption of sedation (DIS) in the sedation assessment group. (A) Peak inspiratory pressure, (B) Respiratory rates. Data are expressed as the mean±SEM. *p<0.05 and †p<0.01 according to Friedman test.

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  Figure 7 Changes in hemodynamic parameters after the implementation of daily interruption of sedation (DIS) in the sedation assessment group. (A) Mean blood pressure, (B) Heart rates. Data are expressed as the mean±SEM.

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