Sedation in mechanically ventilated adults at critical care unit in Kenyatta National Hospital

Abstract

The effective management of pain, anxiety and sleep are the major aims of a sedation therapy regimen. The desired result of a sedation regimen is to allow the patient to tolerate the physical environment and unpleasant procedures and therapies that are necessary in the intensive care unit to facilitate nursing care and management, and reduce anxiety and stress, so that post traumatic stress disorder does not occur after discharge from the unit. The careful and precise maintenance of sedation therapy may lead to better management of the patient requiring mechanical ventilatory support and reduce requirement for use of neuromuscular blocking agents. This prospective cross-sectional study was carried out to study the sedation practice at the critical care unit of KNH from December 2009 to March 2010. A sedation scoring system by Ramsey was used to determine the adequacy of sedation with I being an anxious agitated patient to 6 which was the state of no response by a patient or very deep sedation. The mean age was 37.9 years; total of 87 males (53.7%) comprised the majority of patients while 75 were females 46.3%. Majority of the patients admitted, thirty three (20.5%) were due to retroviral disease this was followed by sepsis 18.6% (30). Midazolam and propofol were the two main drugs that were used for sedation in the CCU; in addition these drugs were administered intravenously both as continuous infusion using pumps and as intermittent bolus injections. In this study, sedation practice was carried out in the critical care unit despite the fact that there was no guiding protocol that was found. Analysis of factors that may hinder patients from getting optimum sedation and use of current guidelines may be the basis of implementing a sedation protocol in the CCU.