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Does an evidence-based sedation protocol improve practice and patient outcomes in critical care?

Bucknall, Tracey K., Manias, Elizabeth and Presneill, Jeffery 2008, Does an evidence-based sedation protocol improve practice and patient outcomes in critical care?, in INRC 2008 : 19th International Nursing Research Congress Focusing on Evidence-Based Practice : Research Sessions, Honor Society of Nursing, Singapore.

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Title Does an evidence-based sedation protocol improve practice and patient outcomes in critical care?
Author(s) Bucknall, Tracey K.
Manias, ElizabethORCID iD for Manias, Elizabeth orcid.org/0000-0002-3747-0087
Presneill, Jeffery
Conference name International Nursing Research Congress (19th : 2008 : Singapore)
Conference location Singapore
Conference dates 7-11 Jul. 2008
Title of proceedings INRC 2008 : 19th International Nursing Research Congress Focusing on Evidence-Based Practice : Research Sessions
Publication date 2008
Publisher Honor Society of Nursing
Place of publication Singapore
Summary
Learning Objective 1: compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care.

Learning Objective 2: explain the contrasting international research findings on sedation protocol implementation.
Minimization of sedation in critical care patients has recently received widespread support. Professional organizations internationally have published sedation management guidelines for critically ill patients to improve the use of research in practice, decrease practice variability and shorten mechanical ventilation duration. Innovations in practice have included the introduction of decision making protocols, daily sedation interruptions and new drugs and monitoring technologies. The aim of this study was to compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients in an Australian critical care setting.

A randomized, controlled trial design was used to study 312 mechanically ventilated adult patients in a general critical care unit at an Australian metropolitan teaching hospital. Patients were randomly assigned to receive protocol directed sedation management developed from evidence based guidelines (n=153) or usual clinical practice (n=159).

The median (95% CI) duration of ventilation was 58 hrs (44–78 hrs) for patients in the non-protocol group and 79 hrs (56–93) for those patients in the protocol group (p=0.20). Results were not significant for length of stay in critical care or hospital, the frequency of tracheostomies, and unplanned extubations. A Cox proportional hazards model estimated that protocol directed sedation management was associated with a 22% decrease (95% CI: 40% decrease to 2% increase, p=0.07) in the occurrence of successful weaning from mechanical ventilation.

Few randomized controlled trials have evaluated the effectiveness of protocol-directed sedation outside of North America. This study highlights the lack of transferability between different settings and different models of care. Qualified, high intensity nursing in the Australian critical care setting facilitates rapid, responsive decisions for sedation management and an increased success rate for weaning from mechanical ventilation.
Language eng
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920210 Nursing
HERDC Research category E3 Extract of paper
Copyright notice ©2008, Honor Society of Nursing
Persistent URL http://hdl.handle.net/10536/DRO/DU:30019251

Document type: Conference Paper
Collection: School of Nursing and Midwifery
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Created: Fri, 11 Sep 2009, 10:40:47 EST

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