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Protocol directed sedation by nurses reduced the duration of mechanical ventilation in critically ill patients

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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?


Randomised (allocation concealed), unblinded, controlled trial.


A medical intensive care unit (ICU) in a university teaching hospital in St Louis, Missouri, USA.


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.


At the time of mechanical ventilation, patients were allocated to 1 of 2 groups. 162 patients received protocol directed sedation by nurses, in which …

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  • Source of funding: Barnes-Jewish Hospital Innovations in Healthcare Program.

  • For correspondence: Dr A D Brook, 10004 Kennerly Road, Suite 310A, St Louis, MO 63128, USA. Fax +1 314 849 8789.