Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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The Significance of Sedation Control in Patients Receiving Mechanical Ventilation

  • Jung, Yun Jung (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Chung, Wou Young (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Lee, Miyeon (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Lee, Keu Sung (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Park, Joo Hun (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Sheen, Seung Soo (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Hwang, Sung Chul (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine) ;
  • Park, Kwang Joo (Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine)
  • Received : 2012.05.16
  • Accepted : 2012.07.30
  • Published : 2012.09.30
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Abstract

Background: Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation. Methods: A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS) was conducted in the SAG. Results: In the SAG, the dose of midazolam was significantly reduced by control of sedation (day 1, $1.3{\pm}0.5{\mu}g/kg/min$; day 2, $0.9{\pm}0.4{\mu}g/kg/min$; p<0.01), and was significantly lower than the ECG on day 2 (p<0.01). Likewise, on day 2, sedation levels were significantly lower in the SAG than in the ECG. Significant relationship was found between Ramsay sedation scale and Richmond agitation-sedation scale (RASS; $r_s$=-0.57), Ramsay Sedation Scale and Bispectral Index (BIS; $r_s$=0.77), and RASS and BIS ($r_s$=-0.79). In 10 patients, who didn't require re-sedation after DIS, BIS showed the earliest and most significant changes among the sedation scales. Ventilatory parameters showed significant but less prominent changes, and hemodynamic parameters didn't show significant changes. No seriously adverse events ensued after the implementation of DIS. Conclusion: Active assessment and control of sedation significantly reduced the dosage of sedatives in patients receiving mechanical ventilation. DIS, conducted in limited cases, suggested its potential efficacy and tolerability.

Keywords

References

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