Purpose: To determine whether the use of continuous intravenous sedation is associated with prolongation of the duration of mechanical ventilation. Methods: Prospective cohort study. The medical intensive care unit (ICU) of Barnes-Jewish Hospital, a university-affiliated urban teaching hospital. Two hundred forty two consecutive ICU patients requiring mechanical ventilation. Results: A total of 93 (38.4%) mechanically ventilated patients recieved continuous intravenous sedation while 149 (61.6%) patients received either bolus administration of intravenous sedation (n=64) or no intravenous sedation (n=85) following intubation. The duration of mechanical ventilation was significantly longer for patients receiving continuous intravenous sedation compared to patients not receiving continuous intravenous sedation (185± 190 hours versus 55.6 ±75.6 hours; P < 0.001) Similarly, the lengths of intensive care (13.5 ± 33.7 days versus 4.8 ± 4.1 days; P < 0.0001) and hospitalization (21.0 ± 25.1 days versus 12.8 ± 14.1 days; P < 0.001) were statistically longer among patients receiving continuous intravenous sedation. Multiple linear regression analysis, adjusting for age, gender, severity of illness, mortality, indication for mechanical ventilation, use of chemical paralysis, presence of a tracheostomy, and the number of acquired organ system derangements, found the adjusted duration of mechanical ventilation to be significantly longer for patients receiving continuous intravenous sedation compared to patients who did not receive continous intravenous sedation (148 hours [95% confidence interval: 121, 175 hours] versus 78.7 hours [95% confidence interval: 68.9, 88.6 hours]; P < 0.001). Conclusions: We conclude that the use of continuous intravenous sedation may be associated with the prolongation of mechanical ventilation. Clinical Implications: These data suggest that strategies targeted at reducing the use of continuous intravenous sedation could shorten the duration of mechanical ventilation for some patients.
|Issue number||4 SUPPL.|
|State||Published - Oct 1 1998|