Date of Award

11-29-2021

Degree Type

Thesis

Degree Name

Master of Science in Nursing (MScN)

First Advisor

Dr. Rubina Barolia

Second Advisor

Ms. Shirin Rahim

Third Advisor

Ms. Fauzia Basaria Hasnani

Department

School of Nursing and Midwifery, Pakistan

Abstract

Background: Sedation is a universal intervention for mechanically ventilated patients, and practices guided by evidence-based literature can help achieve favorable patient outcomes. Despite available evidence-based literature, and recommendations about sedation choice and daily sedation interruption, these practices are not only varying but are also lacking across different hospitals in Pakistan.
Purpose: The study was conducted to compare the clinical outcomes of midazolam, propofol, and dexmedetomidine among mechanically ventilated (MV) patients. Moreover, this study also aimed to evaluate the clinical outcomes of MV patients associated with daily spontaneous awakening trails in the ICUs of a tertiary care hospital, Karachi, Pakistan.
Method: A cross-sectional, quantitative, analytical study design was used to respond to the research questions of the study. The consecutive sampling method was used to recruit 120 eligible mechanically ventilated patients. Chi-square and ANOVA were used to analyze the study results.
Results: The results of the current study showed that the most commonly utilized sedative was propofol (50.8%), followed by midazolam (25%) and dexmedetomidine (24.2%). Moreover, 39.2% of the patients received daily SATs, 37.5% received these occasionally, and 23.3% had never received SATs. Overall, 24.2% of the patients developed delirium, 23.3% had manifested sub-syndromal delirium (SSD), and 19.2% were in deep sedation or coma. Dexmedetomidine was significantly associated with decreased incidences of delirium and deep sedation/coma (p=0.003), shortened time to extubation (p=0.001), duration of MV ventilation (p< 0.001), and ICU length of stay (p=0.001). Furthermore, a higher number of dexmedetomidine-treated patients achieved target sedation than those receiving propofol and midazolam (p>< 0.001). Likewise, daily SATs were significantly associated with lower incidences of delirium (p>< 0.001), sub-syndromal delirium (p>< 0.001), and deep sedation/coma (p>< 0.001); and shortened extubation time (p=0.004), MV duration (p>< 0.001), and ICU LOS (p=0.03).
Conclusion: The study concluded that dexmedetomidine and daily sedation interruption strategy showed promising clinical outcomes among MV patients. This study offers recommendations at the education, research, and policy and practice levels.

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1

Last Page

179

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