1. Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study.
- Author
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Cinotti R, Besnard N, Desmedt L, Floch RL, Perrot P, Bekara F, Klouche K, Larcher R, Mahé PJ, Frasca D, Asehnoune K, Jung B, and Roquilly A
- Subjects
- Adult, Clinical Protocols, Controlled Before-After Studies, Dose-Response Relationship, Drug, Feasibility Studies, Female, Humans, Infusions, Intravenous, Ketamine administration & dosage, Male, Midazolam administration & dosage, Middle Aged, Nurses, Oxycodone administration & dosage, Pain Management, Pain Measurement, Pain, Procedural drug therapy, Pregabalin administration & dosage, Remifentanil administration & dosage, Time Factors, Ventilator Weaning methods, Analgesics, Opioid administration & dosage, Burns therapy, Hypnotics and Sedatives administration & dosage, Pain drug therapy, Respiration, Artificial methods
- Abstract
Background: Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients., Methods: We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU., Results: Eighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%-38%] and median ABSI was 7 [5-9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2-24] vs. 6 days [2-17] (P=0.3) and 17 days [4-32] vs. 8 days [3-23] (P=0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2-24] in the Intervention phase (P=0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P=0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P=0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P=0.6)., Conclusion: Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation., (Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.)
- Published
- 2020
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