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Nurses' sedation practices during weaning of adults from mechanical ventilation in an intensive care unit

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Abstract
Background: Sedation and analgesia have an important impact on the outcome of patients treated with mechanical ventilation. International guidelines recommend use of sedation protocols to ensure best patient care. Objective: To determine the sedation practice of intensive care nurses weaning adults from mechanical ventilation. Methods: A cross-sectional survey with a self-administered questionnaire was used to determine sedation practices of Flemish critical care nurses during weaning. Consensus on content validity was achieved through a Delphi procedure among experts. Data were collected during the 32nd Annual Congress of the Flemish Society of Critical Care Nurses in Ghent, Belgium, December 2014. Results: A total of 342 nurses were included in the study. Of these, 43.7% had a sedation protocol in their unit that was used by 61.8% of the respondents. Sedation protocols were more often available (P<.001) in academic hospitals (72%) than in general hospitals (41.5%). Sedatives were administered via continuous infusion with bolus doses if needed (81%). Level of sedation was assessed every 2 hours (56%), mostly via the Richmond Agitation-Sedation Scale (59.1%). Daily interruption of sedation was used by 16.5% of respondents. The biggest barriers to daily interruption were patient comfort (49.4%) and fear of respiratory worsening (46.6%). Conclusions: A considerable discrepancy exists between international recommendations and actual sedation practices. Standardization of sedation practices across different institutions on a regional and national level may improve the quality of care.
Keywords
NEUROMUSCULAR BLOCKING-AGENTS, CLINICAL-PRACTICE GUIDELINES, CRITICALLY-ILL PATIENTS, DAILY INTERRUPTION, NATIONAL-SURVEY, PROFESSIONALS, ANALGESICS, INFUSIONS, PROTOCOLS, DURATION

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Chicago
Borkowska, Marta, Sonia Labeau, Tom Schepens, Dominique Vandijck, Katrien Van de Vyver, Daphné Christiaens, Christelle Lizy, Bronagh Blackwood, and Stijn Blot. 2018. “Nurses’ Sedation Practices During Weaning of Adults from Mechanical Ventilation in an Intensive Care Unit.” American Journal of Critical Care 27 (1): 32–42.
APA
Borkowska, M., Labeau, S., Schepens, T., Vandijck, D., Van de Vyver, K., Christiaens, D., Lizy, C., et al. (2018). Nurses’ sedation practices during weaning of adults from mechanical ventilation in an intensive care unit. AMERICAN JOURNAL OF CRITICAL CARE, 27(1), 32–42.
Vancouver
1.
Borkowska M, Labeau S, Schepens T, Vandijck D, Van de Vyver K, Christiaens D, et al. Nurses’ sedation practices during weaning of adults from mechanical ventilation in an intensive care unit. AMERICAN JOURNAL OF CRITICAL CARE. 2018;27(1):32–42.
MLA
Borkowska, Marta, Sonia Labeau, Tom Schepens, et al. “Nurses’ Sedation Practices During Weaning of Adults from Mechanical Ventilation in an Intensive Care Unit.” AMERICAN JOURNAL OF CRITICAL CARE 27.1 (2018): 32–42. Print.
@article{8544735,
  abstract     = {Background: Sedation and analgesia have an important impact on the outcome of patients treated with mechanical ventilation. International guidelines recommend use of sedation protocols to ensure best patient care. 
Objective: To determine the sedation practice of intensive care nurses weaning adults from mechanical ventilation. 
Methods: A cross-sectional survey with a self-administered questionnaire was used to determine sedation practices of Flemish critical care nurses during weaning. Consensus on content validity was achieved through a Delphi procedure among experts. Data were collected during the 32nd Annual Congress of the Flemish Society of Critical Care Nurses in Ghent, Belgium, December 2014. 
Results: A total of 342 nurses were included in the study. Of these, 43.7\% had a sedation protocol in their unit that was used by 61.8\% of the respondents. Sedation protocols were more often available (P{\textlangle}.001) in academic hospitals (72\%) than in general hospitals (41.5\%). Sedatives were administered via continuous infusion with bolus doses if needed (81\%). Level of sedation was assessed every 2 hours (56\%), mostly via the Richmond Agitation-Sedation Scale (59.1\%). Daily interruption of sedation was used by 16.5\% of respondents. The biggest barriers to daily interruption were patient comfort (49.4\%) and fear of respiratory worsening (46.6\%). 
Conclusions: A considerable discrepancy exists between international recommendations and actual sedation practices. Standardization of sedation practices across different institutions on a regional and national level may improve the quality of care.},
  author       = {Borkowska, Marta and Labeau, Sonia and Schepens, Tom and Vandijck, Dominique and Van de Vyver, Katrien and Christiaens, Daphn{\'e} and Lizy, Christelle and Blackwood, Bronagh and Blot, Stijn},
  issn         = {1062-3264},
  journal      = {AMERICAN JOURNAL OF CRITICAL CARE},
  keyword      = {NEUROMUSCULAR BLOCKING-AGENTS,CLINICAL-PRACTICE GUIDELINES,CRITICALLY-ILL PATIENTS,DAILY INTERRUPTION,NATIONAL-SURVEY,PROFESSIONALS,ANALGESICS,INFUSIONS,PROTOCOLS,DURATION},
  language     = {eng},
  number       = {1},
  pages        = {32--42},
  title        = {Nurses' sedation practices during weaning of adults from mechanical ventilation in an intensive care unit},
  url          = {http://dx.doi.org/10.4037/ajcc2018959},
  volume       = {27},
  year         = {2018},
}

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