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Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives

2007; BioMed Central; Volume: 11; Issue: 4 Linguagem: Inglês

10.1186/cc5969

1466-609X

Esther K. Wolthuis, Denise P. Veelo, Goda Choi, Rogier M. Determann, Johanna C. Korevaar, Peter E. Spronk, Michaël Kuiper, Marcus J. Schultz,

Family and Patient Care in Intensive Care Units

Abstract Introduction We compared the effects of mechanical ventilation with a lower tidal volume (V T ) strategy versus those of greater V T in patients with or without acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) on the use of opioids and sedatives. Methods This is a secondary analysis of a previously conducted before/after intervention study, which consisting of feedback and education on lung protective mechanical ventilation using lower V T . We evaluated the effects of this intervention on medication prescriptions from days 0 to 28 after admission to our multidisciplinary intensive care unit. Results Medication prescriptions in 23 patients before and 38 patients after intervention were studied. Of these patients, 10 (44%) and 15 (40%) suffered from ALI/ARDS. The V T of ALI/ARDS patients declined from 9.7 ml/kg predicted body weight (PBW) before to 7.8 ml/kg PBW after the intervention ( P = 0.007). For patients who did not have ALI/ARDS there was a trend toward a decline from 10.2 ml/kg PBW to 8.6 ml/kg PBW ( P = 0.073). Arterial carbon dioxide tension was significantly greater after the intervention in ALI/ARDS patients. Neither the proportion of patients receiving opioids or sedatives, or prescriptions at individual time points differed between pre-intervention and post-intervention. Also, there were no statistically significant differences in doses of sedatives and opioids. Findings were no different between non-ALI/ARDS patients and ALI/ARDS patients. Conclusion Concerns regarding sedation requirements with use of lower V T are unfounded and should not preclude its use in patients with ALI/ARDS.