Sedation protocols for intubated patients and noninvasive ventilation: additional concepts for a noniatrogenic intensive care

Introduction

Noninvasive ventilation (NIV) and sedation protocols during invasive mechanical ventilation (IMV) can both separately reduce the duration of mechanical ventilation in ICU patients. However, no study has shown the impact of these two concepts when associated.

Methods

All consecutive patients admitted to a 14-bed medical–surgical ICU were retrospectively studied from 2000 to 2006 after implementation of NIV (2000 to 2001) and sedation protocols (2003 to 2004). The duration of mechanical ventilation shown by categories was analyzed using a chi-square test.

Results

During the 7 years of the study, 2,839 admissions were performed in 2,511 patients (59 ± 17 years, women 36%, medical admission 43%, Simplified Acute Physiology Score II 38 ± 17, mortality in the ICU 17%). The incidence and duration of IMV significantly decreased during the study (P < 0.001) (Figure 1). The NIV use progressively increased during the study period, both in medical and surgical patients.

Figure 1

(abstract P399)

Conclusion

These results showed that the implementation of sedation protocols for intubated patients added to the implementation of NIV decreased moreover the duration of IMV.