Light vs. heavy sedation during mechanical ventilation after oesophagectomy – a pilot experimental study focusing on memory

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Abstract:

Background:

To assess and compare the feasibility and stressful memories of light vs. heavy sedation during post-operative mechanical ventilation. Methods:

Randomized clinical trial in one general intensive care unit (ICU) in a Swedish university hospital. Thirty-six adults were randomly assigned to receive either light [Motor Activity Assessment Scale (MAAS) 3–4] or heavy (MAAS 1–2) sedation with continuous i.v. infusion of propofol during post-operative invasive mechanical ventilation after oesophagectomy. The patients were interviewed at the general ward 5 days post-ICU using the ICU Memory Tool and the ICU Stressful Experience Questionnaire, and 2 months post-ICU using the Impact of Event Scale Revised. Patient data and hourly recorded MAAS values were collected after the interviews. Results:

Seventy-four per cent of the 139 MAAS values in the light sedation group (n=18) and 79% of the 142 in the heavy sedation group (n=18) were within the targeted levels, and the median MAAS scores were 3.0 vs. 1.25, respectively. Intention-to-treat analyses showed no significant difference in the prevalence of stressful memories between groups, including endotracheal tube discomfort, presenting wide 95% confidence intervals for the difference in outcome estimates. Excluding the patients with a prolonged ICU stay (n=3), a higher prevalence of delusional memories was found in the heavy sedation group (31% vs. 0%, P=0.04). Conclusions:

This small randomized-controlled pilot study suggests that a light sedation regimen during short-term post-operative mechanical ventilation after major surgery is feasible without increasing patient discomfort.

Keywords: Sedation; intensive care unit; mechanical ventilation; memory; oesophagectomy

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1399-6576.2008.01702.x

Affiliations: 1: Department of Health Sciences, Division of Nursing, Lund University, Lund, Sweden, 2: Department of Clinical Sciences, Division of Anaesthesiology and Intensive Care, Lund University Hospital, Lund, Sweden,

Publication date: September 1, 2008

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