Protocol directed sedation by nurses reduced the duration of mechanical ventilation in critically ill patients
QUESTION: Is protocol directed sedation by nurses associated with a shorter duration of mechanical ventilation than traditional, non-protocol directed sedation in critically ill patients with acute respiratory failure?
Design
Randomised (allocation concealed), unblinded, controlled trial.
Setting
A medical intensive care unit (ICU) in a university teaching hospital in St Louis, Missouri, USA.
Patients
321 patients >17 years of age (mean age 58 y, 51% women, 58% white) who required mechanical ventilation for acute respiratory failure. Patients were excluded if they were temporarily admitted to the medical ICU and awaiting admission to a surgical ICU.
Intervention
At the time of mechanical ventilation, patients were allocated to 1 of 2 groups. 162 patients received protocol directed sedation by nurses, in which nurses determined if analgesics, sedatives, or both were needed; type of administration (intravenous bolus or continuous intravenous infusion); and dosage. 159 patients …
