|CONTROL ID: 288367
TITLE: ANALGESIA AND SEDATION IN CRITICALLY ILL PATIENTS ON MECHANICAL VENTILATION IN CHILE.
AUTHORS: Tobar, Eduardo1; Aguirre, Marcia1; Lira, Maria T.1; Godoy, Jorge2; Gonzalez, Hugo2; Encalada, Eduardo2; Hernandez, Antonio2; Tomicic, Vinko2; Castro, Jose2; Jara, Juan2; Ugarte, Hector2; Villamizar, Guillermo2; Puccio, Jose M.2; Bugedo, Guillermo1
INSTITUTIONS: 1. Medicina Intensiva y Anestesia, Universidad Catolica, Santiago, Chile. 2. Grupo Chileno de Estudio de Sedacion, Santiago, Chile.
Introduction : Despite evidence-based guidelines, wide variation in sedation schemes and practice are reported in ICUs.
Hypothesis: Our aim was to evaluate the use of sedative drugs, quality of sedation and outcome in patients undergoing mechanical ventilation (MV) in Chile.
Methods : Prospective, observational study during 10 weeks in 13 ICU, involving all adult patients requiring ventilatory support. Nervous system diseases, previous liver or renal failure, second episode of MV, and expected MV shorter than 48 hours were main exclusion criteria. Nurse training was implemented for using a sedation/agitation scale (SAS, Crit Care Med 1999;27:1325) at 12 h interval, and sedative, analgesic and muscle relaxants were registered on a daily basis for the first 7 days, and weekly thereafter. Stepwise logistic regression was used to identify variables independently associated with mortality at 28 days.
Results : We evaluated 635 patients, which 155 (24%) fulfilled inclusion criteria: 57% male, 60±18 yo, APACHE II 19±6, and SOFA 7.8±3.1. Main diagnosis were sepsis 63%, ALI/ARDS 47%, COPD 19%, congestive heart failure 17%, and trauma 9%. Ventilatory parameters at 24 hours were Pa/FiO2 225±97, PEEP 7.7±3.1, and Vt 7.5±1.7 ml/kg.
Of 1907 SAS measurements, 55.4% were 1-2 (deep sopor/coma), 37.1% 3-4 (mild sopor/awake) and 7.4% 5-7 (agitation). Midazolam (86%) and fentanil (81%) were the most frequently used drugs. Muscle relaxants after intubation were used in 30% by bolus or continuous infusion. Mortality (35.5%) was independently associated to SOFA scores (p=0.016), medical condition (p=0.004) and use of muscle relaxants (p=0.012).
Conclusions : In Chile, patients on MV are frequently deeply sedated. Midazolam and fentanil are the preferred drugs, but still 30% of patients use muscle relaxants. Our findings support protocols to improve quality of sedation and outcome of patients on MV.
Funded by FONIS SA05I20091 (gov Chile).