Evaluating the implementation of an analgesia sedation protocol for adult mechanically ventilated patients

Protocol-based pain and sedation protocols reduce sedative requirements, duration of mechanical ventilation, intensive care unit (ICU) length of stay (LOS), and pain intensity in critically ill adults. An analgesia sedation protocol for mechanically ventilated adults was created and implemented in 2022.

This study aimed to assess the implementation and impact of an analgesia sedation protocol for mechanically ventilated adults on opioid and sedative medication administration, level of sedation, and duration of mechanical ventilation.

The creation and implementation of the analgesia sedation protocol was a pharmacist-led, multidisciplinary effort. The protocol is an assessment-driven, stepwise, nurse-protocolized approach to pain and sedation management.

The protocol emphasizes standardized, routine pain assessment and treatment using an analgosedation approach.

This was a single-center, retrospective, cohort study with a pre-post design.

Preprotocol implementation patients received 13% more propofol (odds ratio [OR] 1.1354 [95% CI 1.1310-1.1399]) and 14% less opioid analgesic medications (OR 0.8597 [95% CI 0.8564-0.8630]) relative to the postimplementation cohort. The median Richmond Agitation Sedation Scale score was -2 in both cohorts, and the median Critical Care Pain Observation Tool was 0 in both cohorts. The median duration of mechanical ventilation decreased by 11 hours or 22% (P < 0.001), and the median ICU LOS decreased by 17 hours or 3.9% (P < 0.001) after protocol implementation.

This study confirms successful implementation of an analgosedation protocol through evaluation of opioid and sedative medication exposure. After the implementation, patients received 13% less propofol and 14% more opioid analgesic medications. After protocol implementation, there was a decrease in the duration of mechanical ventilation and ICU LOS.