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Original article
peer-reviewed

The Effect of Daily Sedation-Weaning Application on Morbidity and Mortality in Intensive Care Unit Patients



Abstract

Background/aims

Sedation is one of the most important components of intensive care unit (ICU) in patients who are mechanically ventilated at intensive care conditions. As a result of sedation and analgesia in the intensive care unit, the patient is to be awakened a comfortable and easy process. The aim of the study is to demonstrate the effects of day-time sedation interruptions in intensive care patients.

Material and methods

We made a retrospective review of 100 patients who were monitored, mechanically ventilated and treated at our intensive care unit between January 2008 and January 2013. Patients were divided into two groups, including Group P (continuous infusion of sedative agent) and Group D (daily sedation interruptions - daily recovery).

Demographics, mechanical ventilation time, stay at intensive care unit, hospitalization period, time of first weaning, success of weaning, ventilator-related pneumonia (VRP), total doses of drugs, re-intubation frequency, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) scores and mortality rates of patients were compared. Ramsay Sedation Score (RSS) was used to evaluate the level of sedation. Considering that ideal sedation level is "3" with RSS, RSS < 3 is considered as mild sedation, while RSS > 3 is considered as deep sedation.

Results

There was no difference between demographics of patients. Mechanical ventilation period was significantly longer in Group P than Group D (p < 0.001). When stay at ICU unit was considered, ICU stay was significantly longer in Group P than Group D (p < 0.001). No statistically significant difference was found between two groups with respect to hospitalization period. In inter-group comparison, time to start first weaning was significantly late in Group P than Group D (p < 0.05). There was no difference between groups in terms of frequency of success of weaning and mortality rate (p > 0.05). In inter-group comparison the frequency of reintubation viewed in Group D was significantly less than in Group P (p < 0.05). Considering development of VRP, it was significantly more common in Group P in comparison with Group D (p < 0.05). No statistically significant difference was found between groups in terms of doses of sedative agents (p > 0.05). Considering doses of opioid analgesics, the total dose of fentanyl was significantly higher in Group P than Group D (p = 0.04), while no difference was found for doses of morphine (p > 0.05). Again, no statistical difference was found in doses of muscle relaxant agents (p > 0.05).

Conclusion

It was observed that the sedation technique with daily interruption is superior to continuous infusion of sedatives. Accordingly, we believe that daily weaning will make positive contributions to patients who are mechanically ventilated at intensive care unit.



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Original article
peer-reviewed

The Effect of Daily Sedation-Weaning Application on Morbidity and Mortality in Intensive Care Unit Patients


Author Information

Selcuk Kayir Corresponding Author

Anesthesiology and Reanimation, Hitit University Erol Olcok Training and Research Hospital

Hulya ULUSOY

Anesthesiology and Reanimation, Karadeniz Technical University

Guvenc Dogan

Anesthesiology and Reanimation, Hitit University Erol Olcok Training and Research Hospital


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Karadeniz Technical University Faculty of Medicine Ethics Council issued approval 2013/51. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

The Effect of Daily Sedation-Weaning Application on Morbidity and Mortality in Intensive Care Unit Patients


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Original article
peer-reviewed

The Effect of Daily Sedation-Weaning Application on Morbidity and Mortality in Intensive Care Unit Patients

  • Author Information
    Selcuk Kayir Corresponding Author

    Anesthesiology and Reanimation, Hitit University Erol Olcok Training and Research Hospital

    Hulya ULUSOY

    Anesthesiology and Reanimation, Karadeniz Technical University

    Guvenc Dogan

    Anesthesiology and Reanimation, Hitit University Erol Olcok Training and Research Hospital


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Karadeniz Technical University Faculty of Medicine Ethics Council issued approval 2013/51. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: January 13, 2018

    DOI

    10.7759/cureus.2062

    Cite this article as:

    Kayir S, Ulusoy H, Dogan G (January 13, 2018) The Effect of Daily Sedation-Weaning Application on Morbidity and Mortality in Intensive Care Unit Patients. Cureus 10(1): e2062. doi:10.7759/cureus.2062

    Publication history

    Received by Cureus: December 26, 2017
    Peer review began: January 03, 2018
    Peer review concluded: January 04, 2018
    Published: January 13, 2018

    Copyright

    © Copyright 2018
    Kayir et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background/aims

Sedation is one of the most important components of intensive care unit (ICU) in patients who are mechanically ventilated at intensive care conditions. As a result of sedation and analgesia in the intensive care unit, the patient is to be awakened a comfortable and easy process. The aim of the study is to demonstrate the effects of day-time sedation interruptions in intensive care patients.

Material and methods

We made a retrospective review of 100 patients who were monitored, mechanically ventilated and treated at our intensive care unit between January 2008 and January 2013. Patients were divided into two groups, including Group P (continuous infusion of sedative agent) and Group D (daily sedation interruptions - daily recovery).

Demographics, mechanical ventilation time, stay at intensive care unit, hospitalization period, time of first weaning, success of weaning, ventilator-related pneumonia (VRP), total doses of drugs, re-intubation frequency, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) scores and mortality rates of patients were compared. Ramsay Sedation Score (RSS) was used to evaluate the level of sedation. Considering that ideal sedation level is "3" with RSS, RSS < 3 is considered as mild sedation, while RSS > 3 is considered as deep sedation.

Results

There was no difference between demographics of patients. Mechanical ventilation period was significantly longer in Group P than Group D (p < 0.001). When stay at ICU unit was considered, ICU stay was significantly longer in Group P than Group D (p < 0.001). No statistically significant difference was found between two groups with respect to hospitalization period. In inter-group comparison, time to start first weaning was significantly late in Group P than Group D (p < 0.05). There was no difference between groups in terms of frequency of success of weaning and mortality rate (p > 0.05). In inter-group comparison the frequency of reintubation viewed in Group D was significantly less than in Group P (p < 0.05). Considering development of VRP, it was significantly more common in Group P in comparison with Group D (p < 0.05). No statistically significant difference was found between groups in terms of doses of sedative agents (p > 0.05). Considering doses of opioid analgesics, the total dose of fentanyl was significantly higher in Group P than Group D (p = 0.04), while no difference was found for doses of morphine (p > 0.05). Again, no statistical difference was found in doses of muscle relaxant agents (p > 0.05).

Conclusion

It was observed that the sedation technique with daily interruption is superior to continuous infusion of sedatives. Accordingly, we believe that daily weaning will make positive contributions to patients who are mechanically ventilated at intensive care unit.



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Selcuk Kayir, M.D.

Anesthesiology and Reanimation, Hitit University Erol Olcok Training and Research Hospital

For correspondence:
drskayir@gmail.com

Hulya ULUSOY

Anesthesiology and Reanimation, Karadeniz Technical University

Guvenc Dogan

Anesthesiology and Reanimation, Hitit University Erol Olcok Training and Research Hospital

Selcuk Kayir, M.D.

Anesthesiology and Reanimation, Hitit University Erol Olcok Training and Research Hospital

For correspondence:
drskayir@gmail.com

Hulya ULUSOY

Anesthesiology and Reanimation, Karadeniz Technical University

Guvenc Dogan

Anesthesiology and Reanimation, Hitit University Erol Olcok Training and Research Hospital