The effect of controlled sedation based on Richmond scale on the duration of mechanical ventilation in patients admitted to ICU

Mehrangiz Ghabimi; Monireh Mashhadi; Maryam Rostamvand; Zahra Shafiei; Zohre Tahmasbi; Hamid Hojjati

doi:10.53730/ijhs.v6nS4.11023

Authors

Mehrangiz Ghabimi Department of Medical and Surgical Nursing of Medical_Surgical Nursing, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
Monireh Mashhadi Department of Medical and Surgical Nursing, School of Nursing and Midwifery, Yazd University of Medical Sciences, Yazd, Iran
Maryam Rostamvand Department of Psychiatric Nursing, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
Zahra Shafiei Nursing and midwifery care research center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
Zohre Tahmasbi Department of Nursing, Aliabad Katoul Branch, Islamic Azad University, Aliabad Katoul, Iran
Hamid Hojjati
hamid.hojjati@gmail.com
Department of Nursing, Aliabad Katoul Branch, Islamic Azad University, Aliabad Katoul, Iran

Keywords:

Richmond model, duration mechanical ventilation, patients, ICU admission

Abstract

Background & objective: Patients treated with mechanical ventilation may need sedatives and analgesics due to discomfort, pain, lack of coordination with the device, immunity maintenance, and oxygenation elevation. The use of sedation scoring protocols and systems reduces the duration of mechanical ventilation and hospitalization. Therefore, this study aimed to investigate the effect of controlled sedation based on the Richmond model on the duration of mechanical ventilation in patients admitted to the ICU. Methodology: This experimental study was performed on 60 patients admitted to ICU, who had been selected by simple random sampling and divided in two intervention and control groups. The data collection tools included the Richmond Agitation Sedation Scale (RASS), and Berne separation program checklist. In the intervention group, intervention was performed according to the standard Richmond protocol, but the control group received only the routine care. After the intervention, data were collected at 24 hours, 48 hours and 72 hours after the intervention by SPSS-21 statistical software, and then were analyzed by descriptive statistics (mean, standard deviation) and inferential statistics (paired t-test, independent t-test and repeated measure).

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References

Abdar ME, Rafiei H, Abbaszade A, Hosseinrezaei H, Abdar ZE, Delaram M, et al. Effects of nurses' practice of a sedation protocol on sedation and consciousness levels of patients on mechanical ventilation. Iran J Nurs Midwifery Res. 2013; 18(5):391-5. URL:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877462/

Adib-Hajbaghery M, Ansari A, Azizi-Fini E. Oral care in ICU patients: a review of research evidence. Feyz J Kashan Univ Med Sci. 2011; 15 (3):280-93. URL:http://eprints.kaums.ac.ir/1924/

Azadbakht M K, Mazloom R, Shahabi S, Mani A. Effect of endotoxemia on heart rate dynamics in rat isolated perfused hearts. Physiol Pharmacol. 2013; 17 (1) :15-26

Babamohamadi H, Tangestani F, Soleimani M, Abbasi Dorche S. Effect of a sedation guideline on the duration of mechanical ventilation and length of stay in intensive care unit. J Koomesh. 2017: 380-90. URL: http://eprints.semums.ac.ir/1151/.

Bugedo G, Tobar E, Aguirre M, Gonzalez H, Godoy J, Lira MT, et al. The implementation of an analgesia-based sedation protocol reduced deep sedation and proved to be safe and feasible in patients on mechanical ventilation. Rev Bras Ter Intensiva. 2013; 25 (3): 188-96. URL:https://www.scielo.br/j/rbti/a/tc7sZcF96fGDNXX5QGHXq6k/abstract/?lang=en

Burns SM, Fahey SA, Barton DM, Slack D. Weaning from mechanical ventilation: a method for assessment and planning. AACN Clin Issues Crit Care Nurs. 1991; 2(3): 372-89. DOI: 10.4037/15597768-1991-3003

Carson SS, Bach PB, Brzozowski L, Leff A. Outcomes after long-term acute care. An analysis of 133 mechanically ventilated patients. Am J Respir Crit Care Med. 1999; 159(1): 1568-73. DOI: 10.1164/ajrccm.159.5.9809002

Cinotti R, Besnard N, Desmedt L, Floch RL, Perrot P, Bekara F, et al. Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study. Burns. 2020; 46 (6): 1310-1317. DOI: 10.1016/j.burns.2020.02.009

Diaz R, Heller D. Barotrauma And Mechanical Ventilation. StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2021, StatPearls Publishing LLC.; 2021. URL: https://europepmc.org/article/NBK/nbk545226

Ghanbari A, Mohammad Ebrahimzadeh A, Paryad E, Atrkarroshan Z, Mohammadi M. Factors Affecting the Duration of Weaning from Mechanical Ventilation Based on Burn Scale in the Intensive Care Units. Avicenna J Nurs Midwifery Care. 2018; 26 (1): 23-9. URL:http://nmj.umsha.ac.ir/article-1-1677-en.html;

Ghasemiyeh P, Mohammadi-Samani S, Firouzabadi N, Vazin A, Zand F. A brief ICU residents’ guide: Pharmacotherapy, pharmacokinetic aspects and dose adjustments in critically ill adult patients admitted to ICU. Trends Anaesth Crit Care. 2021; 41: 11-31. DOI: 10.1016/j.tacc.2021.05.004

Guo K, Zhang H, Peng S. [Comparison of two schemes of daily arousal and comfort analgesia and sedation in patients on mechanical ventilation in intensive care unit]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018; 30(10):950-2. DOI: 10.3760/cma.j.issn.2095-4352.2018.010.009

Hanieh Sajadi GAHH. The Effect of Empowerment Program on Participation of Mothers with Premature Infants Hospitalized in Neonatal Intensive Care Unit of Sayyed Shirazi Hospital in Gorgan, in 2018. Indian J Forensic Med Toxicol. 2020; 14 (2): 1269-76. DOI: 10.37506/ijfmt.v14i2.3082

Jeong ES, Lee K. Clinical Application of Modified Burns Wean Assessment Program Scores at First Spontaneous Breathing Trial in Weaning Patients from Mechanical Ventilation. Acute Crit Care. 2018; 33(4):260-8. DOI: 10.4266/acc.2018.00276

McPherson C, Miller SP, El-Dib M, Massaro AN, Inder TE. The influence of pain, agitation, and their management on the immature brain. Pediatr Res. 2020; 88 (2): 168-75. DOI: 10.1038/s41390-019-0744-6

Mohamadi, S., Hojjati, H. The effect of continuous care model on sleep quality in veterans with post-traumatic stress disorder referred to psychiatric clinics of Alborz province. J Mil Med. 2019; 21(4): 418-424. URL:http://militarymedj.ir/browse.php?a_code=A-10-1402-4&sid=1&slc_lang=en

Momen R, Roshandel M, Pishgooie SAH. The effect of Benson relaxation method on pain severity after laminectomy in admitted patients to AJA hospitals. ajaums-mcs. 2018; 4 (3): 168-77. URL:http://mcs.ajaums.ac.ir/browse.php?a_code=A-10-1741&slc_lang=en&sid=1

Mutlu GM, Factor P. Complications of mechanical ventilation. Respir Care Clin N Am. 2000; 6(2):213-52. DOI: 10.1016/s1078-5337(05)70069-1.

Pandharipande PP, Patel MB, Barr J. Management of pain, agitation, and delirium in critically ill patients. Pol Arch Med Wewn. 2014; 124 (3): 114-23.

Phillips ML, Kuruvilla V, Bailey M. Implementation of the Critical Care Pain Observation Tool increases the frequency of pain assessment for noncommunicative ICU patients. Aust Crit Care. 2019; 32 (5): 367-72. DOI: 10.1016/j.aucc.2018.08.007

Pour NH, Mahmoodi-Shan GR, Ebadi A, Behnampour N. Spiritual self-care in adolescents: A qualitative study. Int J Adolesc Med Health. 2022; 34(2):49-57. DOI: 10.1515/ijamh-2019-0248

Roos-Blom M-J, Dongelmans D, Stilma W, Spijkstra JJ, de Jonge E, de Keizer N. Association between organizational characteristics and adequate pain management at the intensive care unit. J Crit Care. 2020; 56: 1-5. DOI: 10.1016/j.jcrc.2019.11.010

Rouhalamini A, Fallahzade H, Nasiriani K. Comparing the Persian version properties of Behavioral Pain Scale and Critical Care Pain Observation Tool in patients with head trauma. J Koomesh. 2021; 23(3): 55-347.

Salmani F. The Effect of Discontinuation Protocol on the Duration of Mechanical Ventilation. IJN. 2013; 26 (82): 62-73. URL: https://ijn.iums.ac.ir/browse.php?a_id=1567&sid=1&slc_lang=en

Sedighi L, Mollai Z, Ahmadi M, Bolourchifard F. The Effect of Using Behavioral Pain Scale (BPS) by Nurses on Diagnosis of Pain and Relief Care in ICU Patients. Avicenna J Nurs Midwifery Care. 2019; 27(4):260-8. URL: http://nmj.umsha.ac.ir/browse.php?a_id=1956&sid=1&slc_lang=en&html=1

Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002; 166(10): 1338-44. DOI: 10.1164/rccm.2107138

Sieber M, Rudiger A, Schüpbach R, Krüger B, Schubert M, Bettex D. Outcome, demography and resource utilization in ICU Patients with delirium and malignancy. Sci Rep. 2021 Sep 21;11(1):1-0. [PubMed] DOI: 10.1038/s41598-021-98200-8.

Skoczyński S, Ogonowski M, Tobiczyk E, Krzyżak D, Brożek G, Wierzbicka A, et al. Risk factors of complications during noninvasive mechanical ventilation -assisted flexible bronchoscopy. Adv Med Sci. 2021; 66(2): 246-53. [PubMed] DOI: 10.1016/j.advms.2021.04.001.

Suryasa, I. W., Rodríguez-Gámez, M., & Koldoris, T. (2021). Get vaccinated when it is your turn and follow the local guidelines. International Journal of Health Sciences, 5(3), x-xv. https://doi.org/10.53730/ijhs.v5n3.2938

Tadrisi SD, Madani SJ, Farmand F, Ebadi A, Zarchi AA, Saghafinia, et al. Richmond agitation-sedation scale validity and reliability in intensive care unit adult patients Persian version. Iran J Crit Care Nurs. 2009; 2(1): 15-21. URL:

Taran Z, Namadian M, Faghihzadeh S, Naghibi T. The effect of sedation protocol using Richmond Agitation-Sedation Scale (RASS) on some clinical outcomes of mechanically ventilated patients in intensive care units: a randomized clinical trial. J Caring Sci. 2019; 8(4):199. [PubMed] DOI: 10.15171/jcs.2019.028.

Torres-Castro R, Lima Í, Resqueti VR, Fregonezi GA. Weaning from mechanical ventilation in people with neuromuscular disease: a systematic review. BMJ open. 2021; 11(9):e047449. DOI: 10.1136/bmjopen-2020-047449. URL: https://www.sid.ir/en/Journal/ViewPaper.aspx?ID=841863

Vasilevskis EE, Pandharipande PP, Graves AJ, Shintani A, Tsuruta R, Ely EW, et al. Validity of a Modified Sequential Organ Failure Assessment Score Using the Richmond Agitation-Sedation Scale. Crit Care Med. 2016; 44 (1): 138-44. DOI: 10.1097/CCM.0000000000001375

Wahyuni, S., Chalid, S. M. T., Pelupessy, N. U., Arifuddin, S., Idris, I., & Usman, A. N. (2022). Comparison of the use of shock index and modified early obstetric warning score in COVID-19 obstetric emergency patients as ICU care parameters. International Journal of Health & Medical Sciences, 5(1), 80-90. https://doi.org/10.21744/ijhms.v5n1.1844

Wiatrowski R, Norton C, Giffen D. Analgosedation: Improving Patient Outcomes in ICU Sedation and Pain Management. Pain Manag Nurs. 2016; 17 (3): 204-17. DOI: 10.1016/j.pmn.2016.02.052.

Williams TA, Martin S, Leslie G, Thomas L, Leen T, Tamaliunas S, et al. Duration of mechanical ventilation in an adult intensive care unit after introduction of sedation and pain scales. Am J Crit Care. 2008; 17 (4): 349-56. DOI: 10.4037/ajcc2008.17.4.349

Yazdannik AR, Salmani F, Irajpour AR, Abasi S. Effect of the Nurse-directed weaning readiness assessment on the duration of mechanical ventilation: a randomized clinical trial. Qom Univ Med Sci J. 2013; 7(4):89-94. URL: https://journal.muq.ac.ir/browse.php?a_code=A-10-1 294&slc_lang=en&sid=1

Yeganeh MR, Gholami S, Tabari R, Atrkar Roshan Z, Rimaz S, pouralizadeh M. The effect of controlled sedation based on the Richmond scale on the duration of mechanical ventilation and the changes of blood pressure in patients following coronary artery bypass graft surgery: A randomized clinical trial. Hayat. 2018; 23 (4): 372-86. URL:https://hayat.tums.ac.ir/article-1-1937-en.html

Yousefi H, Toghyani F, Yazdannik AR, Fazel K. Effect of using Richmond Agitation Sedation Scale on duration of mechanical ventilation, type and dosage of sedation on hospitalized patients in intensive care units. Iran J Nurs Midwifery Res. 2015; 20(6):700. [PubMed] DOI: 10.15171/jcs.2019.028.