Article

OBJECTIVES: To (1) reduce deep sedation and delirium to permit mobilization, (2)
increase the frequency of rehabilitation consultations and treatments to improve
patients' functional mobility, and (3) evaluate effects on length of stay.
DESIGN: Seven-month prospective before/after quality improvement project.
SETTING: Sixteen-bed medical intensive care unit (MICU) in academic hospital.
PARTICIPANTS: 57 patients mechanically ventilated 4 days or longer. INTERVENTION:
A multidisciplinary team focused on reducing heavy sedation and increasing MICU
staffing to include full-time physical and occupational therapists with new
consultation guidelines. MAIN OUTCOME MEASURES: Sedation and delirium status,
rehabilitation treatments, functional mobility. RESULTS: Compared with before the
quality improvement project, benzodiazepine use decreased markedly (proportion of
MICU days that patients received benzodiazepines [50% vs 25%, P=.002]), with
lower median daily sedative doses (47 vs 15 mg midazolam equivalents [P=.09] and
71 vs 24 mg morphine equivalents [P=.01]). Patients had improved sedation and
delirium status (MICU days alert [30% vs 67%, P<.001] and not delirious [21% vs
53%, P=.003]). There were a greater median number of rehabilitation treatments
per patient (1 vs 7, P<.001) with a higher level of functional mobility
(treatments involving sitting or greater mobility, 56% vs 78%, P=.03). Hospital
administrative data demonstrated that across all MICU patients, there was a
decrease in intensive care unit and hospital length of stay by 2.1 (95%
confidence interval: 0.4-3.8) and 3.1 (0.3-5.9) days, respectively, and a 20%
increase in MICU admissions compared with the same period in the prior year.
CONCLUSIONS: Using a quality improvement process, intensive care unit delirium,
physical rehabilitation, and functional mobility were markedly improved and
associated with decreased length of stay.
CI - Copyright 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS