7.8.2 An evaluation of daily sedation vacation in mechanically ventilated patients within the adult intensive care milieu and its impact on patient outcomes (127)

Jenni Templeman, Critical Care Practice Development Facilitator, Intensive Care Unit, Macclesfield Hospital, Macclesfield, United Kingdom jenni.templeman@echeshire-tr.nwest.nhs.uk

Abstract:

Background:

The purpose of the study was to evaluate the efficacy of daily sedation vacation practice in relation to length of mechanical ventilator days and length of stay in the intensive care unit and its impact on patient outcomes. Cost of sedative therapy and intensive care bed days was also evaluated. Continuous sedative infusions are widely administered in intensive care units to reduce pain, distress and anxiety. These carefully titrated infusions also assist the tolerance of entracheal and tracheostomy tubes, facilitate modes of mechanical ventilation, bronchial toilet and suctioning, physiotherapy and generalised care. Daily sedation vacation is an integral component of the 'ventilator care bundle', which encompasses seven evidence-based research practices.

Method:

A retrospective comparative pilot study of Level III intensive care participants was conducted with a 2003 group of n = 20 participants (before the introduction of daily sedation vacation) and a 2006 group of n = 20 participants (after the introduction of daily sedation vacation). Data was retrieved from the ICNARC database and patient case notes. Participants from the two groups were matched as closely as possible according to admission diagnosis. APACHE II scores, length of ventilator days and length of stay were analysed by the Mann-Whitney U test using SPSS software.

Results:

The results in the 2006 group reflected a mean reduction in ventilator days = 12.3 (p = 0.001) and length of stay = 12 (p = 0.001). In addition, a cost reduction of £3,862.00 was evident with regard to sedative therapy and £18,000.00 - £22,000.00 in length of stay in intensive care in the 2006 group.

Conclusion:

In adult mechanically ventilated patients within a general intensive care unit, daily sedation vacation practice improves patient outcomes by decreasing the duration of length of ventilator days, length of stay, sedative therapy costs and intensive care costs.

Biography:

Jenni heralds from Cape Town, South Africa. Academic achievements include the Diploma in General Nursing Science, Midwifery, Intensive Care Nursing Science and the BSc degree in Nursing Education and Community Health Nursing Science. During her nursing career, she has worked within the realms of aviation medicine (Europe Assist and Flight for Life Helicopter Services) and has accumulated a substantial amount of fixed-wing flying hours transporting critically ill patients both within South Africa and on a worldwide basis. Her educational experiences as a critical care tutor and training consultant have afforded her the opportunity to work in close collaboration with the Universities of Cape Town, Witwatersrand and Stellenbosch. She arrived in the United Kingdom 7 years ago and her job profile included working in a cardio-thoracic intensive care unit and teaching at the Trafford Critical Care Skills Centre. At present, she is the Critical Care Practice Development Facilitator at Macclesfield Hospital, co-facilitator of the Macclesfield Critical Care Practice Development and Research Unit and is a part-time lecturer in Critical Care at the University of Chester. Jenni is currently in her dissertation year of the Masters in Research Degree at the University of Salford.