Outcomes before and after implementation of a standardized pain and agitation protocol in obese mechanically ventilated patie Thomas C. Neal, Belinda Li, Jennifer Sandi, Julia Pate TriStar Centennial Medical Center - Nashville, TN
Background/Purpose: Determine if standardized pain and agitation practices improved outcomes for obese mechanically ventilated patients.
Methodology: Inclusion criteria require that patients be at least 18 years old, mechanically ventilated, and have a body mass index greater than 30. Excluded populations are post-operative cardiovascular surgery patients, patients requiring high dose benzodiazepines or barbiturates for management of alcohol and benzodiazepine withdrawal, and patients admitted for status epilepticus. Patients with a clinical requirement for deep sedation were also excluded. Pre-implementation data and post-implementation data were collected from August through December of 2016 and 2017, respectively. The primary endpoint was 28-day ventilator-free days.
Results: Fifty-four patients were included in the study. Baseline characteristics between groups were similar. The primary endpoint was not significantly different between the pre- and post-implementation groups (23.28 days vs. 23.00 days; p=0.809). The protocol resulted in a significant increase in the frequency of pain assessment (median pain scores per day: 4.88 vs. 6.08, p=0.001). Concurrently, less fentanyl was used in the pre-implementation cohort, but it was only in this group that increased fentanyl usage was significantly correlated to fewer ventilator-free days (R2= -0.413; p=0.032).
Conclusions: The implementation of a standardized pain and agitation protocol did not change the duration of mechanical ventilation in obese patients. However, pain was assessed significantly more often which may have contributed to safer use of fentanyl for pain and agitation despite increased fentanyl administration as a result of the protocol.
Presentation Objective: To describe patient-centered outcomes before and after the introduction of a standardized pain and agitation protocol among obese mechanically ventilated patients.
Self-Assessment: What method of sedation does the 2013 Society of Critical Care Medicine guideline for the management of pain, agitation, and delirium recommend for mechanically ventilated adult patients?
