내과계 중환자실 전담 약사의 진통 진정 프로토콜 관리 및 중재에 대한 효과
Effect of Pharmacist’s Intervention and Management of Pain and Sedation Protocol on Clinical Outcomes in Medical ICU
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Background : An ICU pharmacist plays a pivotal role in promoting adherence to protocolized analgo- sedation strategy. The purpose of this study was to validate the impact of a pharmacist’s intervention on clinical outcomes in a medical ICU. Methods : The pharmacist reinformed physicians and nurses in the use of the protocol, emphasizing intermittent analgesic dosing prior to starting continuous infusions and daily sedation interruption. Additionally, formal audit and feedback were conducted regularly. In the control group, 145 admissions were collected retrospectively over a 3-month period from February to April 2014. In the intervention group, 141 admissions were reviewed prospectively over a 3-month period from June to August 2014. Results : After intervention, duration of ICU stay or mechanical ventilation did not change signfiicantly (median: 2.9 days vs. 3.2 days; 3.5 days vs. 3.8 days, respectively). Although there was a trend toward increased continuous opioid use (median total dose per patients: 9,512.5 mcg vs. 10,266.7 mcg) and decreased used of benzodiazepine and propofol (median total dose per patients: 1,318.5 mg vs. 190.7 mg; 5,587.5 mg vs. 2,653.3 mg, respectively), differences were not statistically significant. However, the proportion of days deeply sedated was decreased (Richmond Agitation Sedation Scale - 4, -5: 25.7% vs. 20.0%). The proportion of days awake without being delirious or having coma showed a trend of increase (negative Confusion Assessment Method for ICU: 50.0% vs. 57.0%). Furthermore, the proportion of comatose days was decreased (35.2% vs. 24.1%, p 0.041). Conclusions : A pharmacist’s intervention for implementing the sedation protocol did not significantly decrease the duration of stay in the ICU or mechanical ventilation, although it might minimize deep sedation and delirium.
Abstract
Background : An ICU pharmacist plays a pivotal role in promoting adherence to protocolized analgo- sedation strategy. The purpose of this study was to validate the impact of a pharmacist’s intervention on clinical outcomes in a medical ICU. Methods : The pharmacist reinformed physicians and nurses in the use of the protocol, emphasizing intermittent analgesic dosing prior to starting continuous infusions and daily sedation interruption. Additionally, formal audit and feedback were conducted regularly. In the control group, 145 admissions were collected retrospectively over a 3-month period from February to April 2014. In the intervention group, 141 admissions were reviewed prospectively over a 3-month period from June to August 2014. Results : After intervention, duration of ICU stay or mechanical ventilation did not change signfiicantly (median: 2.9 days vs. 3.2 days; 3.5 days vs. 3.8 days, respectively). Although there was a trend toward increased continuous opioid use (median total dose per patients: 9,512.5 mcg vs. 10,266.7 mcg) and decreased used of benzodiazepine and propofol (median total dose per patients: 1,318.5 mg vs. 190.7 mg; 5,587.5 mg vs. 2,653.3 mg, respectively), differences were not statistically significant. However, the proportion of days deeply sedated was decreased (Richmond Agitation Sedation Scale - 4, -5: 25.7% vs. 20.0%). The proportion of days awake without being delirious or having coma showed a trend of increase (negative Confusion Assessment Method for ICU: 50.0% vs. 57.0%). Furthermore, the proportion of comatose days was decreased (35.2% vs. 24.1%, p 0.041). Conclusions : A pharmacist’s intervention for implementing the sedation protocol did not significantly decrease the duration of stay in the ICU or mechanical ventilation, although it might minimize deep sedation and delirium.
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