Mechanical Ventilator Sedation

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Mechanical Ventilator Sedation

• Victoria Pham Randazzo, RN,BSN,C,CCRN

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Issues with Mechanical Ventilator Patients that
Lead to Use of Sedation

• Comfort
• Unstable hemodynamics
• Stress

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Issues with Sedation

• Over-sedation
• Prolong ventilation days
• Neurological delays
• Unnecessary consults
• Increase Length of ICU/hospitalization
• Increase risk of Ventilator Acquired Pneumonia

• Under-sedation
• Self-extubation
• Physiologic stress response
• Unstable hemodynamics
• Ventilator dysynchrony

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Research

• Clinical needs
• Differing perceptions about sedation for
  ventilated patients
• Physicians vs. nurses
• Novice nurses vs. experienced nurses
• Inconsistent practices in ICUs for sedation
• Evidence of benefits of nurse-driven sedation
  protocol
• Decrease length of ventilator
• Decrease use of restraints
• Decrease risk of agitation during weaning

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Implementation Process

• Support from management
• Interest from individual staff nurses
• Multidisciplinary team
• Resources available
• Nursing Research Facilitator Dana Rutledge
• Librarian - Julie Smith
• Management Nurse managers and clinical
  coordinators
• Physician Champion
• Several staff nurse champions
• Respiratory therapy champions
• Pharmacy champions

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Protocols Developed

• Policy
• Scientific evidence
• Roles of nurses, mds, respiratory therapists
• Order sets
• Fact sheet (used for education)

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Education

• Staff train-the-trainer
• March 2 week period
• Ams/pms
• Factsheet
• One-on-one training using team members and staff
  nurse champions

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Barriers

• Lack of adherence to policy by mds, nurses, RTs
• Collaboration not ideal at first
• Time involved in education
• Staff comfort in doing it the old way
• Over time.patience, persistence and passion

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Evaluation

• Ongoing
• Processes
• Adherence to specific elements of policy
• Outcomes
• Initial
• Ventilator LOS perhaps a change
• Restraint usage - decreased
• Adjuvant analgesics no change
• Eventual
• ICU LOS
• Diprovan usage

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Sequelae

• Multidisciplinary collegiality
• Improved patient outcomes
• Pointed to need for policies/order sets r/t
• Delirium/agitation
• End of life sedation
• Sedation in neurologic patients

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Use of the Iowa Model of EBP

• Describe how this helped