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Critical Care

, 12:R70

First Online: 20 May 2008Received: 01 May 2008Revised: 13 May 2008Accepted: 20 May 2008

Abstract

IntroductionDaily interruption of sedation DIS and sedation algorithms SAs have been shown to decrease mechanical ventilation MV duration. We conducted a randomized study comparing these strategies.

MethodsMechanically ventilated adults 18 years old or older in the medical intensive care unit ICU were randomly assigned to DIS or SA. Exclusion criteria were severe neurocognitive dysfunction, administration of neuromuscular blockers, and tracheostomy. Study endpoints were total MV duration and 28-day ventilator-free survival.

ResultsThe study was terminated prematurely after 74 patients were enrolled DIS 36 and SA 38. The two groups had similar age, gender, racial distribution, Acute Physiology and Chronic Health Evaluation II score, and reason for MV. The Data Safety Monitoring Board convened after DIS patients were found to have higher hospital mortality; however, no causal connection between DIS and increased mortality was identified. Interim analysis demonstrated a significant difference in primary endpoint, and study termination was recommended. The DIS group had longer total duration of MV median 6.7 versus 3.9 days; P = 0.0003, slower improvement of Sequential Organ Failure Assessment over time 0.70 versus 0.23 units per day; P = 0.025, longer ICU length of stay 15 versus 8 days; P < 0.0001, and longer hospital length of stay 23 versus 12 days; P = 0.01.

ConclusionIn our cohort of patients, the use of SA was associated with reduced duration of MV and lengths of stay compared with DIS. Based on these results, DIS may not be appropriate in all mechanically ventilated patients.

Trial registrationClinicalTrials.gov NCT00205517.

AbbreviationsABCAwakening and Breathing Controlled

ANOVAanalysis of variance

APACHEAcute Physiology and Chronic Health Evaluation

CIconfidence interval

DISdaily interruption of sedation

DSMBData Safety Monitoring Board

ICUintensive care unit

IQRinterquartile range

IRBInstitutional Review Board

MVmechanical ventilation

RASSRichmond Agitation-Sedation Scale

SAsedation algorithm

SBTspontaneous breathing trial

SOFASequential Organ Failure Assessment.

Electronic supplementary materialThe online version of this article doi:10.1186-cc6908 contains supplementary material, which is available to authorized users.

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Autor: Marjolein de Wit - Chris Gennings - Wendy I Jenvey - Scott K Epstein

Fuente: https://link.springer.com/







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