Safety and acceptability of patient-administered sedatives during mechanical ventilation

Linda L. Chlan, Debra J. Skaar, Mary F. Tracy, Sarah M. Hayes, Breanna D Hetland, Kay Savik, Craig R. Weinert

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Safety and acceptability of sedative selfadministration by patients receiving mechanical ventilation is unknown. Objectives To determine if self-administration of dexmedetomidine by patients is safe and acceptable for selfmanagement of anxiety during ventilatory support. Methods In a pilot trial in 3 intensive care units, 17 intubated patients were randomly assigned to dex medetomidine and 20 to usual care. Dexmede tomidine was administered via standard pumps for patient- controlled analgesia, with a basal infusion (0.1-0.7 μg/kg per hour) titrated by the number of patient-triggered doses (0.25 μg/kg per dose). Safety goals were heart rate greater than 40/min, systolic blood pressure greater than 80 mm Hg, and diastolic blood pressure greater than 50 mm Hg. Acceptability was based on patients' self-reported satisfaction and ability to administer the sedative. A 100-mm visual analog scale was used daily to assess patients' anxiety. Results The sample was 59% male and 89% white. Mean values were age, 50.6 years; score on the Acute Physiology and Chronic Health Evaluation, 60.1; and protocol duration, 3.4 days. Five dexmedetomidine patients had blood pressure and/or heart rate lower than safety parameters, necessitating short-term treatment. Nurses' adherence to reporting of safety parameters was 100%; adherence to the dexmedetomidine titration algorithm was 73%. Overall baseline anxiety score was 38.4 and did not change significantly (βday = 2.1; SE, 2.5; P = .40). Most dexmedetomidine patients (92%) were satisfied or very satisfied with their ability to self-administer medication. Conclusions For select patients, self-administration of dexmedetomidine is safe and acceptable.

Original languageEnglish (US)
Pages (from-to)288-296
Number of pages9
JournalAmerican Journal of Critical Care
Volume26
Issue number4
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

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Patient Safety
Hypnotics and Sedatives
Artificial Respiration
Dexmedetomidine
Blood Pressure
Safety
Aptitude
Self Administration
Anxiety
Heart Rate
Medetomidine
Patient-Controlled Analgesia
APACHE
Visual Analog Scale
Intensive Care Units
Nurses

ASJC Scopus subject areas

  • Critical Care

Cite this

Safety and acceptability of patient-administered sedatives during mechanical ventilation. / Chlan, Linda L.; Skaar, Debra J.; Tracy, Mary F.; Hayes, Sarah M.; Hetland, Breanna D; Savik, Kay; Weinert, Craig R.

In: American Journal of Critical Care, Vol. 26, No. 4, 01.07.2017, p. 288-296.

Research output: Contribution to journalArticle

Chlan, Linda L. ; Skaar, Debra J. ; Tracy, Mary F. ; Hayes, Sarah M. ; Hetland, Breanna D ; Savik, Kay ; Weinert, Craig R. / Safety and acceptability of patient-administered sedatives during mechanical ventilation. In: American Journal of Critical Care. 2017 ; Vol. 26, No. 4. pp. 288-296.
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abstract = "Background Safety and acceptability of sedative selfadministration by patients receiving mechanical ventilation is unknown. Objectives To determine if self-administration of dexmedetomidine by patients is safe and acceptable for selfmanagement of anxiety during ventilatory support. Methods In a pilot trial in 3 intensive care units, 17 intubated patients were randomly assigned to dex medetomidine and 20 to usual care. Dexmede tomidine was administered via standard pumps for patient- controlled analgesia, with a basal infusion (0.1-0.7 μg/kg per hour) titrated by the number of patient-triggered doses (0.25 μg/kg per dose). Safety goals were heart rate greater than 40/min, systolic blood pressure greater than 80 mm Hg, and diastolic blood pressure greater than 50 mm Hg. Acceptability was based on patients' self-reported satisfaction and ability to administer the sedative. A 100-mm visual analog scale was used daily to assess patients' anxiety. Results The sample was 59{\%} male and 89{\%} white. Mean values were age, 50.6 years; score on the Acute Physiology and Chronic Health Evaluation, 60.1; and protocol duration, 3.4 days. Five dexmedetomidine patients had blood pressure and/or heart rate lower than safety parameters, necessitating short-term treatment. Nurses' adherence to reporting of safety parameters was 100{\%}; adherence to the dexmedetomidine titration algorithm was 73{\%}. Overall baseline anxiety score was 38.4 and did not change significantly (βday = 2.1; SE, 2.5; P = .40). Most dexmedetomidine patients (92{\%}) were satisfied or very satisfied with their ability to self-administer medication. Conclusions For select patients, self-administration of dexmedetomidine is safe and acceptable.",
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N2 - Background Safety and acceptability of sedative selfadministration by patients receiving mechanical ventilation is unknown. Objectives To determine if self-administration of dexmedetomidine by patients is safe and acceptable for selfmanagement of anxiety during ventilatory support. Methods In a pilot trial in 3 intensive care units, 17 intubated patients were randomly assigned to dex medetomidine and 20 to usual care. Dexmede tomidine was administered via standard pumps for patient- controlled analgesia, with a basal infusion (0.1-0.7 μg/kg per hour) titrated by the number of patient-triggered doses (0.25 μg/kg per dose). Safety goals were heart rate greater than 40/min, systolic blood pressure greater than 80 mm Hg, and diastolic blood pressure greater than 50 mm Hg. Acceptability was based on patients' self-reported satisfaction and ability to administer the sedative. A 100-mm visual analog scale was used daily to assess patients' anxiety. Results The sample was 59% male and 89% white. Mean values were age, 50.6 years; score on the Acute Physiology and Chronic Health Evaluation, 60.1; and protocol duration, 3.4 days. Five dexmedetomidine patients had blood pressure and/or heart rate lower than safety parameters, necessitating short-term treatment. Nurses' adherence to reporting of safety parameters was 100%; adherence to the dexmedetomidine titration algorithm was 73%. Overall baseline anxiety score was 38.4 and did not change significantly (βday = 2.1; SE, 2.5; P = .40). Most dexmedetomidine patients (92%) were satisfied or very satisfied with their ability to self-administer medication. Conclusions For select patients, self-administration of dexmedetomidine is safe and acceptable.

AB - Background Safety and acceptability of sedative selfadministration by patients receiving mechanical ventilation is unknown. Objectives To determine if self-administration of dexmedetomidine by patients is safe and acceptable for selfmanagement of anxiety during ventilatory support. Methods In a pilot trial in 3 intensive care units, 17 intubated patients were randomly assigned to dex medetomidine and 20 to usual care. Dexmede tomidine was administered via standard pumps for patient- controlled analgesia, with a basal infusion (0.1-0.7 μg/kg per hour) titrated by the number of patient-triggered doses (0.25 μg/kg per dose). Safety goals were heart rate greater than 40/min, systolic blood pressure greater than 80 mm Hg, and diastolic blood pressure greater than 50 mm Hg. Acceptability was based on patients' self-reported satisfaction and ability to administer the sedative. A 100-mm visual analog scale was used daily to assess patients' anxiety. Results The sample was 59% male and 89% white. Mean values were age, 50.6 years; score on the Acute Physiology and Chronic Health Evaluation, 60.1; and protocol duration, 3.4 days. Five dexmedetomidine patients had blood pressure and/or heart rate lower than safety parameters, necessitating short-term treatment. Nurses' adherence to reporting of safety parameters was 100%; adherence to the dexmedetomidine titration algorithm was 73%. Overall baseline anxiety score was 38.4 and did not change significantly (βday = 2.1; SE, 2.5; P = .40). Most dexmedetomidine patients (92%) were satisfied or very satisfied with their ability to self-administer medication. Conclusions For select patients, self-administration of dexmedetomidine is safe and acceptable.

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