Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay
Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay
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DOI：
10.1097/01.ccm.0000300275.63811.b3
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发表时间：
2008-02-01
影响因子：
8.8
通讯作者：
Theodore, Arthur C.
中科院分区：
文献类型：
--
作者：
Marshall, John;Finn, Christine A.;Theodore, Arthur C.
目的：虽然在重症监护病房使用指导镇静镇痛治疗的方案已被证明可以改善患者的预后，但依从性往往较差。我们假设一个正式的，一致的药剂师干预，以促进遵守我们机构的镇静指南将改善临床结果。本研究的目的是记录每日药剂师干预对重症监护病房患者持续镇静治疗的临床结果的影响。设计：前后对照研究。环境：大学医疗中心的两间重症监护室（共18张病床）。患者：156例机械通气患者，在重症监护病房持续输液镇静药物。干预措施：在回顾性组中，收集所有接受持续镇静输注的机械通气患者3个月的数据。在前瞻性组中，一名药剂师评估了所有每天使用持续镇静的机械通气患者，并建议他们遵守该机构先前批准的镇静指南。测量和主要结果：收集了78例对照组和78例干预组患者的数据。两组在基线人口统计数据方面匹配良好。机械通气的平均持续时间从干预前组的338 +/- 348小时（14天）减少到干预后组的178 +/- 178小时（7.4天）（p < 0.001）。干预后组重症监护室住院时间（380 +/- 325小时vs 238 +/- 206小时，p = .001）和住院时间（537 +/- 350小时vs 369 +/- 274小时，p = .001）也显著缩短。结论：每日药剂师强制干预的制度旨在改善镇静指南的依从性，导致接受持续镇静的患者机械通气时间显著减少。
Objective: While the use of a protocol to guide sedation and analgesia therapy in the intensive care unit has been shown to improve patient outcomes, compliance is often poor. We hypothesized that a formal, consistent intervention by pharmacists to promote adherence to our institution's sedation guidelines would improve clinical outcomes. The purpose of this study was to document the impact of daily pharmacist interventions on clinical outcomes of intensive care unit patients prescribed continuous sedative therapy.Design: Before-after study.Setting: Two medical intensive care units (total of 18 beds) at a university medical center.Patients: Patients were 156 mechanically ventilated patients prescribed a continuous infusion of sedative medication while in the medical intensive care unit.Interventions: In the retrospective group, data were collected on all mechanically ventilated patients receiving continuous sedative infusions over a 3-month period. In the prospective group, a pharmacist evaluated all mechanically ventilated patients on continuous sedation daily and made recommendations to adhere to the institution's previously approved sedation guidelines.Measurements and Main Results: Data were collected for 78 control and 78 intervention patients. The groups were well matched in terms of baseline demographics. The mean duration of mechanical ventilation was reduced from 338 +/- 348 hrs (14 days) in the pre-intervention group to 178 +/- 178 hrs (7.4 days) in the postintervention group (p < .001). Durations of both intensive care unit stay (380 +/- 325 hrs vs. 238 +/- 206 hrs, p = .001) and hospital stay (537 +/- 350 hrs vs. 369 +/- 274 hrs, p = .001) were also significantly reduced in the post intervention group.Conclusions: The institution of a daily pharmacist-enforced intervention directed at improving sedation guideline adherence resulted in a significant decrease in the duration of mechanical ventilation in patients receiving continuous sedation.