Episode 81: Choose Wisely
How does automatically starting continuous sedation right after intubation lead to ventilator acquired pneumonia,hospital acquired infections, diaphragm dysfunction, delirium, failed extubation, reintubation, readmission to the ICU, tracheostomy, PEG tube, prolonged time on the ventilator, and discharge to a care facility for months of rehabilitation?
This case study should forever change the responsibility we feel for patient outcomes.
References:
Immobility →Ventilator Associated Pneumonia
Delirium
Sedation Contributes/Causes ICU Acquired Weakness
ICU Acquired Weakness/Prolonged Time on Ventilator and Hospital
Strøm, T., Martinussen, T., & Toft, P. (2010). A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet (London, England), 375(9713), 475–480. https://doi.org/10.1016/S0140-6736(09)62072-9
Discharge Disposition
Brook, A. D., Ahrens, T. S., Schaiff, R., Prentice, D., Sherman, G., Shannon, W., & Kollef, M. H. (1999). Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Critical care medicine, 27(12), 2609–2615.5.
Pun, B. T., Balas, M. C., Barnes-Daly, M. A., Thompson, J. L., Aldrich, J. M., Barr, J., Byrum, D., Carson, S. S., Devlin, J. W., Engel, H. J., Esbrook, C. L., Hargett, K. D., Harmon, L., Hielsberg, C., Jackson, J. C., Kelly, T. L., Kumar, V., Millner, L., Morse, A., Perme, C. S., … Ely, E. W. (2019). Caring for Critically Ill Patients with the ABCDEF Bundle: Results of the ICU Liberation Collaborative in Over 15,000 Adults. Critical care medicine, 47(1), 3–14. https://doi.org/10.1097/CCM.0000000000003482
Diaphragm Dysfunction / Risk of re-intubation:
ICU Acquired Weakness and Failed Extubation
