(955) Protocolized Minimal Sedation vs Conventional Sedation in Mechanically Ventilated Critically Ill

Introduction: Literature supports the use of a protocolized goal-directed sedation strategy for mechanically ventilated critically ill patients. However, a specific validated protocol has yet to be defined in the literature. We aim to assess whether critically ill patients managed with a protocolized minimal sedation strategy targeting light sedation results in improvement of clinical outcomes as opposed to conventional care.

Methods: A retrospective, single-center study investigating clinical outcomes associated with the use of a protocolized minimal sedation strategy versus conventional care was conducted. Mechanically ventilated adults admitted from September 2021 through August 2022 were included if their disease state did not preclude the use of light sedation. The primary outcome was duration of mechanical ventilation. Secondary outcomes included ventilator free days, hospital mortality and length of stay, discharge disposition, concomitant benzodiazepine use, and unplanned extubation. A randomized sample of 30 patients were reviewed to assess RASS, CPOT, and nursing compliance.

Results: In total, 134 patients were included in the protocolized minimal sedation group and 156 were included in the conventional sedation group. The primary outcome of median ventilator duration was 25.8 hours (IQR, 11.7-53.4) in the minimal sedation group and 37.2 hours (IQR, 16.3-89.7) in the conventional sedation group (p = 0.191). Median ventilator free days did not differ between groups. Hospital length of stay, mortality, percentage of patients discharged home, and benzodiazepine use were also similar between groups. Unplanned extubation was uncommon in either group. Deep sedation (RASS -4 to -5) was only observed in the conventional sedation group. Compliance to the minimal sedation protocol was impacted by the transition between peri-intubation and post-intubation sedation, and only 20% of patients received appropriate protocol escalations.

Conclusions: While there were no statistically significant differences between interventions, there was a trend towards benefit in reduction of mechanical ventilation duration and hospital length of stay. Compliance to our minimal sedation protocol was limited, which may have affected outcomes. Future prospective studies involving larger patient populations are warranted.