According to a new study, waking intensive care unit patients and having them breathe on their own decreased both sedation levels and coma prevalence.
The research team from the Regenstrief Institute and the Indiana University Center for Ageing Research also report that the Wake UP and Breathe programme showed a trend toward reduced delirium in critically ill patients. The study has been published in Critical Care Medicine.
702 Eskenazi Health ICU patients 18 years and older participated in the study. There was no change in ICU staffing policies as the Wake Up and Breathe programme was integrated into the clinical workflow.
Nearly five million Americans are admitted to the ICU every year. Over a third of these patients receive mechanical ventilation because they are comatose, have lung disease, pneumonia or sepsis or other health reasons due to which they cannot maintain an open airway. Patients on a ventilator typically receive sedatives and painkillers.
While too little sedation can lead to patient agitation and unplanned disconnection from the ventilator, excessive sedation can result in a longer need for the ventilator and an extended stay in the ICU. In addition, excessive pain medication and sedation is also associated with acute brain dysfunction characterised by coma and sedation.
"Being on too high a dose of sedation medications or painkillers isn't good for the brain, especially the ageing brain. Typically about 80 percent of patients in an ICU develop delirium," said Babar A. Khan, MD, the pulmonologist and critical care physician who led the study. "In our study, in a real-world setting -- an ICU of a large public hospital that was supportive of our programme -- we stopped sedation in the morning and woke patients up to breathe on their own with assistance from an interdisciplinary team of nursing, physicians and respiratory therapists. Only 50 percent developed delirium, still too high a number, but significantly better than typical."
Dr. Khan points out that assisted breathing over a period of time is bad for the body because it increases muscle atrophy and can also cause physical function problems. The Wake Up and Breathe programme showed an increase in the duration of mechanical ventilation but patients were awake and breathing spontaneously. While the reasons behind the increase were unclear, the one thing that is obvious is the need to get people off ventilators sooner.
Source: Indiana University
Image Credit: Wikimedia Commons