Analgesia-First Sedation in Trauma Patients
MemorialCare Health System
Summary
The study's aim is to ascertain the best approach for providing sedation and pain management for patients who have sustained trauma and are requiring respiratory support from a mechanical ventilator. The common approach to patients who need mechanical ventilation is to provide continuous drips of sedatives and pain medicine and awaken the patient once a day to check the brain functions. Another approach is to provide pain medicine and reserve sedatives for only a short duration when needed. The difference between approaches has not been studied in Trauma patients.
Description
A significant proportion of patients admitted to the intensive care unit (ICU) require mechanical ventilation (MV). To facilitate care and maintain comfort for patients requiring MV, the utilization of a large quantity of sedatives and analgesics is required with either continuous infusion or intermittent dosing. However, prolonged continuous administration of sedatives and analgesics can contribute to prolonged MV. Numerous studies have shown that instituting protocol-directed sedation (PDS) by continuous infusion of sedatives and analgesics using a protocol that includes a daily interruption…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. ≥ 18 years of age 2. Mechanically ventilated with an expected duration of MV ≥ 48h 3. Initiated continuous sedative/analgesic infusions by the ICU team 4. Patient is a candidate for MV weaning Exclusion Criteria: 1. Admission after resuscitation from cardiac arrest 2. Significant neurological deficit due to a chronic disorder 3. History of alcohol dependence and/or other illicit drug abuse 4. Prior administration of continuous sedative/analgesic from a transferring institution 5. Patient receiving neuromuscular blocking agents 6. Allergy to midazolam, lorazepam, and/o…
Interventions
- OtherAnalgesia First Sedation Strategy for Mechanically Ventilated (MV) Trauma Subjects
The Intervention is using a sedation strategy for MV trauma that initially targets pain by intermittent boluses followed by an IV drip only if required. Sedatives are limited to agitation management and for a limited duration as needed. This "analgo-sedation" approach differs from the approach of using IV drips of analgesics and sedatives simultaneously and discontinuing both once daily to assess subjects.
- OtherProtocol Directed Sedation and Daily Sedation Interruption
The active comparator in this study is using a sedation strategy for MV trauma that uses IV drips of analgesics and sedatives simultaneously and discontinues both once daily to assess subjects.
Location
- Long Beach Memorial Medical CenterLong Beach, California