TY - JOUR
T1 - Patient-controlled sedation
T2 - A novel approach to sedation management for mechanically ventilated patients
AU - Chlan, Linda L.
AU - Weinert, Craig R.
AU - Skaar, Debra J.
AU - Tracy, Mary Fran
PY - 2010/11/1
Y1 - 2010/11/1
N2 - Background: Patient self-administration of medications for analgesia and procedural sedation is common. However, it is not known whether mechanically ventilated ICU patients can self-administer their own sedation to manage symptoms. Methods: This descriptive pilot study examined the safety, adequacy, and satisfaction of patient-controlled sedation (PCS) with a convenience sample of critically ill, mechanically ventilated patients (N = 17) in the ICUs at University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota. Dexmedetomidine was administered via a patient-demand infusion pump system for a maximum of 24 h. Pumps were programmed with basal infusion plus patient-triggered boluses; nurses adjusted the basal infusion based on a dosing algorithm. Data were collected on sedation adequacy, additional dosing of analgesics and sedatives, hemodynamic parameters, safety of PCS, patient satisfaction with PCS, and nurse satisfaction with PCS. Results: Although a majority of the hemodynamic values were within the established safety parameters for the study, 25% of patients experienced mild adverse physiologic effects. Furthermore, despite patients' perception of sedation adequacy with PCS, 70% received supplemental opiates or benzodiazepine medications while participating in the study. Patients rated dexmedetomidine PCS favorably for self-management of anxiety, level of relaxation obtained, and comfort in self-administering sedation. Nurses also were generally satisfied with PCS as a method of sedation, dexmedetomidine as the sedative, and patient response to the sedation. Conclusions: PCS warrants further investigation as a means to promote comfort in mechanically ventilated critically ill patients.
AB - Background: Patient self-administration of medications for analgesia and procedural sedation is common. However, it is not known whether mechanically ventilated ICU patients can self-administer their own sedation to manage symptoms. Methods: This descriptive pilot study examined the safety, adequacy, and satisfaction of patient-controlled sedation (PCS) with a convenience sample of critically ill, mechanically ventilated patients (N = 17) in the ICUs at University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota. Dexmedetomidine was administered via a patient-demand infusion pump system for a maximum of 24 h. Pumps were programmed with basal infusion plus patient-triggered boluses; nurses adjusted the basal infusion based on a dosing algorithm. Data were collected on sedation adequacy, additional dosing of analgesics and sedatives, hemodynamic parameters, safety of PCS, patient satisfaction with PCS, and nurse satisfaction with PCS. Results: Although a majority of the hemodynamic values were within the established safety parameters for the study, 25% of patients experienced mild adverse physiologic effects. Furthermore, despite patients' perception of sedation adequacy with PCS, 70% received supplemental opiates or benzodiazepine medications while participating in the study. Patients rated dexmedetomidine PCS favorably for self-management of anxiety, level of relaxation obtained, and comfort in self-administering sedation. Nurses also were generally satisfied with PCS as a method of sedation, dexmedetomidine as the sedative, and patient response to the sedation. Conclusions: PCS warrants further investigation as a means to promote comfort in mechanically ventilated critically ill patients.
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U2 - 10.1378/chest.09-2615
DO - 10.1378/chest.09-2615
M3 - Article
C2 - 20299632
AN - SCOPUS:78349243692
VL - 138
SP - 1045
EP - 1053
JO - Diseases of the chest
JF - Diseases of the chest
SN - 0012-3692
IS - 5
ER -