Patient-controlled sedation: a novel approach to sedation management for mechanically ventilated patients

• Published in: Chest Vol. 138; no. 5; p. 1045
• Main Authors: Chlan, Linda L, Weinert, Craig R, Skaar, Debra J, Tracy, Mary Fran
• Format: Journal Article
• Language: English
• Published: United States 01.11.2010
• Subjects: Analgesia, Patient-Controlled - methods; Conscious Sedation - methods; Critical Illness - therapy; Dexmedetomidine - administration & dosage; Female; Follow-Up Studies; Humans; Hypnotics and Sedatives - administration & dosage; Infusion Pumps; Infusions, Intravenous; Intensive Care Units; Male; Middle Aged; Minnesota; Pain Management; Pain Measurement; Patient Satisfaction; Pilot Projects; Respiration, Artificial; Retrospective Studies; Minnesota
• ISSN: 1931-3543
• DOI: 10.1378/chest.09-2615

Patient self-administration of medications for analgesia and procedural sedation is common. However, it is not known whether mechanically ventilated ICU patients can self-administer their own sedation to manage symptoms. This descriptive pilot study examined the safety, adequacy, and satisfaction of patient-controlled sedation (PCS) with a convenience sample of critically ill, mechanically ventilated patients (N = 17) in the ICUs at University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota. Dexmedetomidine was administered via a patient-demand infusion pump system for a maximum of 24 h. Pumps were programmed with basal infusion plus patient-triggered boluses; nurses adjusted the basal infusion based on a dosing algorithm. Data were collected on sedation adequacy, additional dosing of analgesics and sedatives, hemodynamic parameters, safety of PCS, patient satisfaction with PCS, and nurse satisfaction with PCS. Although a majority of the hemodynamic values were within the established safety parameters for the study, 25% of patients experienced mild adverse physiologic effects. Furthermore, despite patients' perception of sedation adequacy with PCS, 70% received supplemental opiates or benzodiazepine medications while participating in the study. Patients rated dexmedetomidine PCS favorably for self-management of anxiety, level of relaxation obtained, and comfort in self-administering sedation. Nurses also were generally satisfied with PCS as a method of sedation, dexmedetomidine as the sedative, and patient response to the sedation. PCS warrants further investigation as a means to promote comfort in mechanically ventilated critically ill patients.