Open Access
Subscription Access
Open Access
Subscription Access
Effect of Nursing Implemented Sedation and Pain Protocol on The Level of Sedation, Pain and Amount of Sedative and Analgesic Drugs Use Among Opium Addicted Critically Ill Patients
Subscribe/Renew Journal
Background and Aim: Control of pain and sedation in addicted critically ill patients could be different from other admitted patients to intensive care unit (ICU). This study aimed to assess the effect of nursing implemented sedation and pain protocol on the level of sedation, pain and amount of sedative and analgesic drugs use in opium addicted critically ill patients.
Methods: In a prospective, randomized, controlled trial from September 2011 to June 2012, this study has been conducted in Kerman, Iran. We randomly assigned 37 addicted mechanically ventilated patients who admitted to ICU in two groups; while in intervention group (group I), patients sedated using sedation and pain protocol, in control group (group II), addicted patients received usual, none protocol directed sedation and pain. Using Richmond Agitation Sedation Scale (RASS) and behavioral pain scale (BPS), the level of sedation and pain of patients was assessed in the time of ICU admission and every 4 hours for the first 2 days. Dosage of sedative and analgesic medications used (Morphine and Midazolam) was recorded in special chart every 6 hours by researcher during this period.
Finding: Mean score of the RASS in time of ICU admission was -1.74±1.1 in group I and -1.81±1.1 in group II. During hospitalization in ICU, score of this scale reached up to -1.10±1.0 in group I and -1.63±1.1 in group II. In the time of ICU admission, mean of BPS in patients in group I and II were 7.9±1.3 and 8.0±1.6, respectively. During ICU stay, score of this scale reached to 5.8±1.6 in group I and 6.9±2.1 in group II. In addition, our results showed that group I patients have received less amount of Morphine and Midazolam in comparison with patients in group II.
Conclusion: Our results suggested that using nursing implemented sedation and pain protocol for opium addicted critically ill, could lead to experience better sedation and lower level of pain as well as decreasing amount of sedative and analgesics drugs use with implementation of protocol.
Keywords
- AhmadiNejad M, Rafiei H. (2011). Pressure ulcer incidence in intensive care unit patients in Bahonar Hospital, Kerman. J Iran Soc Anaesthesiol Intensive Care; 57:10–6.
- Askay SW, Bombardier CH, Patterson DR. (2009). Effect of acute and chronic alcohol abuse on pain management in a trauma center. Expert Rev Neurother; 9:271–77.
- Brook AD, et al. (1998). Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med; 27:2609 - 15.
- Brush DR.(2009). Sedation and analgesia for the mechanically ventilated Patient. Clin Chest Med; 30: 131–41.
- De Wit M et al. (2007). Prevalence and impact of alcohol and other drug use disorders on sedation and mechanical ventilation: a retrospective study. BMC Anesthesiology; 7:3.
- Eduardo TA. (2008). Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation. Rev Méd Chile; 136: 711-18.
- Egerod I, Jensen MB, Herling SF, Welling KL. (2010). Effect of an analgo-sedation protocol for neurointensive patients: a twophase interventional non-randomized pilot study. Critical Care; 14:71.
- Hillman K, Bishop G. (2004). Clinical Intensive Care and Acute Medicine. Cambridge University Press, Cambridge; 89.
- Iranmanesh S, Rafiei H, Sabzevari S. (2012). Relationship between Braden scale score and pressure ulcer development in patients admitted in trauma intensive care unit. Int Wound J; 9:248–52.
- Keller BP, Van Ramsshorst JB, Van Der Verken C. (2002). Pressure ulcers in intensive care patients: a review of risks and prevention. Intensive Care Med; 28:1379–88.
- Payen J et al. (2001) Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med; 29:2258-63.
- Quenot PG et al. (2008). Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Cri Care Med; 35:2031-6.
- Rafiei H, et al. (2012). The prevalence of potential drug interaction in intensive care unit. IJCCN; 4:191-96.
- Riverea AS et al. (2008). Effect of a nursing-implemented sedation protocol on weaning outcome. Crit Care Med; 6:2054- 60.
- Robinson BR, et al. (2008). An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J Trauma; 65:517-26.
- Scemons D, Elston D. (2009). Nurse to Nurse Wound Care. Mc Graw Hill. New York; 67.
- Sedation and Analgesia Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine.(2002). Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med; 30:119- 41.
- Sessler CN et al. (2002). The richmond agitation–sedation scale validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med; 166:1338–44.
- Smith GF, Yeung J. (2010). Core Topic in Critical Care Medicine. Cambridge University Press, Cambridge; 77.
- Suchyta MR, Hopkins RO, Beck C, Jephson A. (2006). Prevalence of alcohol abuse, drug abuse and psychiatric disorders in icu patients. Am J Resp Crit Care Med; 3:A737.
- Urden L D, Stacy K M, Lough M E. (2010). Critical Care Nursing Diagnosis and Management 6th ed. Mosby, St Louis; 162.
- Walker N, Gillen P. (2006). Investigating nurses’ perceptions of their role in managing sedation in intensive care: An exploratory study. Intensive and Critical Care Nursing; 22:338-45.
Abstract Views: 1329
PDF Views: 0