الفهرس 
Chronic obstructive pulmonary diseaseOnly 14 pages are availabe for public view
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Abstract
Critically ill patients who require mechanical ventilation are often given contiouous intravenous infusions of sedative drugs to treat anxiety benzodiazepines are the agents most commonly given, some patients are given other nonanalgesic sedatives, such as propofol or haloperidol. Opiates are often given as well, since nonopiate sedatives have no analgesic properties. New approaches to mechanical ventilation, often involving the use of permissive hypercapnia (i.e., allowing partial pressure of arterial carbon dioxide to reach 50 mm Hg or higher), can cause patients substantial discomfort, necessitating high levels of sedation.
In many intensive care units, sedatives are infused continuously as compared with intermittent bolus infusion, this approach provides a more constant level of sedation and may increase patients’comfort. However, administration of sedatives by continuous infusion has been identified as an independent predictor of a longer duration of mechanical ventilation as well as a longer stay in the intensive care unit and in the hospital.
Continuous infusion of sedatives has other disadvantage Extended sedation may limit clinicians ability tointerpret physical examinations. It may be difficult to distinguish changes in mental status that are due to the action of a sedative from those that are due to neurologic injury. Therefore, clinicians may be compelled to order diagnostic studies to rule out new neurologic injury when patients do not awaken rapidly after the sedative infusion is discontinued.
The benefit of administering sedatives by continuous infusion must be balanced against these disadvantages. Daily interruption of sedative infusions to allow patients to “wake up” may improve the situation by allowing clinicians to streamline the administration of sedatives while ensuring optimal comfort for patients.
The aim of this work was to compare between continuous sedation protocol versus interrupted sedation protocol in COPD mechanically ventilated patients with respect to duration of mechanical ventilation, the time needed for patients to awaken, and the frequency of adverse events.
This study was carried out on 45 subjects of both sexes, who were presented to Critical Care Department, Benha University Hospital and Benha Teaching Hospital. Patients were presented with signs and symptoms of COPD and proven radiologically, according to the GOLD guidelines, based on sustained (48 hours or more) worsening of dyspnea, cough, or sputum production leading to an increase in the use of maintenance medications or supplementations with additional medications.
Subjects were categorized into three groups; 15 mechanically ventilated COPD patients received continuous sedation protocol (group 1), 15 mechanically ventilated COPD patients with daily interruption sedation protocol (group 2) and 15 mechanically ventilated COPD patients without protocol of sedation (group 3).
Patients in which we anticipated death to occur within 24 hours or who were scheduled for withdrawal of life support, patients whose level of sedation could not be scored due to underlying neurologic condition, patients who had experienced cardiopulmonary resuscitation, patients who used continuous sedatives for seizure therapy, and patients who were admitted to the department of critical care after previously having used mechanical ventilation or sedative drugs were excluded.
In this study, all the groups were matched with respect to age, gender, smoking status, nutritional status, and indications for MV. Patient age in the continuous sedation group was greater than other groups, where the median was 58, 55, and 50 respectively, and the mean was 53, 49, and 47 respectively. Male Percentage in all groups was greater than female percentage, but the highest percentage was in the continuous sedation group (67% male compared with 33% female).
Regarding smoking status, the percentage of current smokers was greater in all groups, patients without protocol of sedation included the hihgest percentage of current smokers (60%), and interrupted sedation group was the greater percentage of current nonsmokers (40%).
All groups consisted of higher percentage from good nutrition (60%, 53%, and 67% respectively) than malnourished patients. CO2 narcosis is the major indication for MV, then severe respiratory distress, cardiorespiratory arrest. Other indications were the lowest percentage as indications for MV.
In our study, duration of mechanical ventilation was significantly shorter in interrupted sedation group and group without protocol of sedation compared to the continuous sedation group. However, duration of mechanical ventilation was similar in interrupted sedation protocol group compared to group without protocol of sedation.
The time for patients to awaken was significantly shorter in interrupted sedation group and group without protocol of sedation compared to the continuous sedation group. However, the time for patients to awaken was similar in interrupted sedation protocol group compared to group without protocol of sedation. The frequencies of adverse events were similar in the groups with insignificant difference.