Systematic Review of Effects of Sedatives on Patient Ventilation

National University of Ireland Galway
NU502 Advanced
Research Methods
Assignment-Research Protocol
Systematic Review of Effects of Sedatives on Patient Ventilation
*Do Sedation Breaks Reduce Ventilation Time?

Introduction
Nursing care in the I.C.U. (Intensive Care Unit) is multi-faceted and challenging, with the care of
the mechanically ventilated patient at the center of their practice. The care of the ventilated
patient requires a good knowledge of mechanical ventilation and invasive monitoring. Sedation
is an important element of caring for ventilated patients. Sedation relieves anxiety and
discomfort caused by procedures such as intubation. Adequate sedation supports a calm and
comfortable experience for the patient. Multiple complications exist from over/under sedation.
Daily sedation breaks have proven to be beneficial to the patient with respect to long term
psychological outcomes (Nassar et al, 2015). The longer a patient is ventilated and sedated, the
longer the stay in ICU, the higher the risk of developing delirium. In 2011, Ely from Vanderbilt
University Hospital Tennessee suggested that 80% of ventilated patients experience delirium.
Most patients who require analgesia and sedation infusions are ventilated at the same time
(Pandharipande, 2007). The relationship between the two is paramount in ensuring patient
comfort and safety and helps in the reduction of ventilation time. Use of analgesia and sedation
can prevent pain and anxiety, allows for invasive procedures, reduces stress and oxygen
consumption, and improves patient synchrony with the ventilator. (Curley, 2015, 380) Sedation
preference depends on the hospital, patient history and the Clinician’s choice. Thiscan lead to a
wide discrepancy in patient sedation. Sedation also helps to reduce environmental pollution of
the critical care environment, which is usually filled with a high level of background noise with
people and the alarms of the machines. Sedation in the ICU can reduce the following: stress
Áine Considine-
Student Number-17234430
Date-23/04/18
Word Count-2045

endogenous catecholamine activity, increased oxygen consumption, tachycardia,
hypercoagulability, hyper metabolism, and immunosuppression and anxiety that include
sympathetic response. (Curley 2015, 382)
The time taken from the start of ventilation to the start of weaning depends largely on the
sedatives used and on the duration of sedation. Some hospitals give their patients daily sedation
breaks while some leave the patients on a continuous break or some give fewer breaks or no
breaks. Among these patients there was a notable difference in the start of weaning from
ventilation and extubating. (Kress et al 2003, 1459). Daily sedation interruptions and regular
administration of sedatives are effective in reducing ventilation time although it is not clear
which method is more favorable.
To encourage best practice with sedation management this research proposal will aim to review
if daily sedation breaks can reduce ventilation time in ICU patients. Primarily this research
centers on achieving scientific facts based on careful observation, objective sampling, data
analysis and factual conclusion. (Kress, 2003). It will be a quantitative systematic review.
Justification
Patients in intensive care units require life-support techniques including mechanical ventilation.
ICU patients experience anxiety, pain, and deprivation of sleep resulting from illness (Holm and
Dreyer 2017, p.83). As a result, proper pain control and adequate sedation are key procedures
required in the management of ICU patients. Specifically, sedation facilitates intubation,
ventilation, and tolerance of tubes (Vincent 2017, p.11). The management of these patients
requires continuous infusion of sedative drugs so the stability of blood vessels is maintained
(Page and McAuley 2015, p.141). On the contrary, administration of too many sedative drugs

can both increase the time taken on mechanical ventilation as well as enhance the side effects
such as pneumonia (Balter et al and Conti et al 2016, p.206). To avoid the build-up of sedative
drugs into body and side effects, dose adjustment methods are used. One of the principal
methods is sedation interruption.
The use of DSI as a method of reducing mechanical ventilation and the time taken in ICU has
fundamental conflicts. Devlin and Roberts (2011, p. 571), Hughes, McGrane and Panharipande
(2012, p. 41), Kress et al. (2000, p.1474), Pinder and Christensen (2008, p.68), and Kallet et al.
(2018, p.7) indicate that sedation interruption not only allows the body time to clear sedative
drugs but also makes the patient relatively more awake and ready hence earlier liberation from
the ICU. In addition, the study shows that lack of sedation breaks results in poor long-term
outcomes such as psychological stress. Similarly, Barr et al. (2013, p.301) indicates that protocol
sedation reduces the duration of mechanical ventilation. On the other hand, Shebabi et al (2012,
p. 725) argues that DSI does not alter time taken in mechanical ventilation. Instead, sedation
reduces response to environmental factors, depression, and stress. As a result, it is important to
have an updated systematic review on the effects of DSI on time taken in mechanical ventilation.
The principal objective of this systematic review will be ton compare the total duration of
mechanical ventilation for ICU patients who were managed with DSI against those with no DSI.
The primary research question will be to find out if sedation breaks reduce the time for
mechanical ventilation.
Methodology
Search Methods