- 作者：Russel J. Roberts ; Marjolein de Wit ; Scott K. Epstein ; Dorothy Didomenico ; John W. Devlin
- 关键词：Sedation ; Mechanical ventilation ; Intensive care unit ; Critical care ; Daily interruption ; Nurse ; Nursing ; Survey ; Predictors
- 刊名：Journal of Critical Care
- 出版年：2010
- 出版时间：December 2010
- 年：2010
- 卷：25
- 期：4
- 页码：660.e1-660.e7
- 全文大小：141 K
PurposeThe aim of the study was to identify the nurse and patient-related factors predicting daily interruption of sedation (DIS) performance by nurses in the intensive care unit (ICU).Methods
Nurses, caring for a mechanically ventilated patient receiving 24 hours or more of a continuously infused sedative, were interviewed at the bedside to determine their willingness to perform DIS on this patient and to determine the influence of 20 nurse- and 47 patient-related factors on DIS completion.
Results
The 57 (44 % ) of 130 of nurses willing to perform DIS had performed DIS at least once in the past (P < .0001) and were not targeting deep sedation (ie, Sedation Agitation Scale [SAS] ≤ 2 [P = .03]). The DIS performance was less likely with use of higher-dose continuous midazolam (P = .006), a fraction of inspired oxygen (Fio2) greater than 50 % (P = .03), or positive end-expiratory pressure greater than 5 mm Hg (P = .006) and in patients either deeply sedated (SAS ≤ 2) (P = .05) or agitated (SAS ≥ 5) in the past 24 hours (P = .003). Prior DIS experience (odds ratio [OR], 2.54; P = .004), hours of sedation-related continuing education (OR, 1.13; P = .02), and a target of deep sedation (OR, 0.49; P = .02) were independent nurse-related factors for DIS performance. Nurse's willingness to conduct DIS ranged from 45 % to 80 % based on the interaction between patient sex, current Fio2, and agitation in past 24 hours.
Conclusions
Educational strategies and institutional protocols focused on improving use of DIS need to consider the various nurse- and patient-related factors that affect DIS performance by nurses in the ICU.