Comparison of the effect of two method: routine sedation and nursing - implemented sedation protocol on the level of patient sedation

To compare a practice of protocoldirected sedation during mechanical ventilation implemented by nurses with traditional nonprotocol- directed sedation administration. Design: Quasi experimental. Setting: A medical intensive care unit (ICU) in a university teaching hospital in Kerman, Iran. Patients:132 patients 15 – 48 years of age (mean age group 21-30 y, 81% men, 97% intubated) who required mechanical ventilation for at least 48 hours. Patients were excluded if had history of heart and lung disease (eg COPD). Intervention: At the time of mechanical ventilation, patients were allocated to 1 of 2 groups. 66 patients received protocol directed sedation by nurses, in which nurses determined if analgesics, sedatives, or both were needed; according to an algorithm-based sedation guideline. 66 patients received traditional, sedatives and analgesics were adjusted according to physician's orders and researchers document observations. Mean of sedation level by Richmond scale, mean of pain level with BPS scale, evry 2h over 48h. Analysis was by intention to treat. Mean Richmond scale after intervention decrased in both group of patients (p=0.0001) but this difference in P group (mean:-.94) compared with NP group (mean:-1.88) more adjust with aim of ideal sedation. (Richmond scale:-1 to 1). Mean BPS scale after intervention decrased in both grop of patients (from bps 6.17 decrased to 3.135 p=0.7) but this difference not significant. (3.1 in nonprotocol v 3.17 in protocol p=0.08). Protocol directed sedation by nurses provided a beter sedation and more adjust with aim of ideal sedation.