Evaluation of midazolam prescription in an adult ICU with a focus on patient safety
DOI:
https://doi.org/10.55892/jrg.v7i15.1550Keywords:
Sedation, Midazolam, RASS Scale, Mechanical VentilationAbstract
Introduction: Sedation is a pharmacological strategy to assist patients who are on mechanical ventilation in the ICU, with midazolam being one of the main medications administered to provide comfort to the patient, as well as to allow the adequate performance of invasive procedures. In this context, to assess and monitor the patient's update with values attributable to their sedation, a frequently used tool is the Richmond Sedation Scale (RASS). Thus, this research proposes to evaluate the prescribed doses of midazolam in patients on mechanical ventilation in the ICU, juxtaposing them with the RASS classification. This study was carried out in the intensive care unit (ICU) of a university hospital from March to May 2023. General data related to the research participants, dose and flow rate of IV midazolam in the prescription and assessment of sedation by the RASS scale were found in the records of physicians and nurses. In total, 145 prescriptions were confirmed and it was observed that 83% were presented doses above the expected dose, calculated according to the patient's weight. When analyzing the level of sedation, discrepancies were observed between the records of health professionals (doctors and nurses), as well as deep sedation for most of the patients analyzed. Thus, the study highlighted the use of midazolam in high doses, differences between the sedation assessments described by professionals and several patients in deep sedation, which may have an impact on increased hospital stay and mortality. In this context, updating and training the clinical protocol, as well as the inclusion of the drug in this practice, are necessary strategies for optimizing hospital resources and therapeutic success.
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AMIB. Orientações sobre o manejo de medicamentos analgésicos, sedativos e bloqueadores neuromusculares para intubação traqueal, manutenção de pacientes em ventilação mecânica e anestesia em situações de escassez no contexto da pandemia COVID-19.
https://www.amib.org.br/fileadmin/user_upload/amib/2021/marco/22/Orientacoe s_sobre_manejo_de_medicamentos_no_contexto_da_pandemia_COVID- 19_210321.pdf
AZULINO ACO, SOLER O, ARRUDA JEG. Intervenção farmacêutica na antibioticoterapia do idoso: caminhos para a redução da ocorrência de problemas relacionados a medicamentos e promoção da farmacoeconomia. Rev Eletr Acervo Saúde,12(11), p.1-8. 2020.
BALZER F, WEIß B, KUMPF O, TRESKATSCH S, SPIES C, WERNECKE KD, et al.
Early deep sedation is associated with decreased in-hospital and two-year follow-up survival. Crit Care, 19(1), p.197. 2015.
BARBOSA TP, BECCARIA LM, BASTOS AS, SILVA DC. Association between sedation level and mortality of intensive care patients on mechanical ventilation. Rev Esc Enferm USP, 54:e03628. 2020.
BARR J, FRASER GL, PUNTILLO K, ELY EW, GÉLINAS C, DASTA JF, et al.
Clinical practice guidelines for the management of pain, agita-tion, and delirium in adult patients in the intensive care unit. Critical care medicine [Internet]. 41(1), p. 263-306. 2013.
DOS SANTOS PN et al. Avaliação da sedoanalgesia pelo monitoramento do índice bispectral em uma Unidade de Terapia Intensiva Covid: a importância das intervenções farmacêuticas. Revista Brasileira de Pesquisa em Saúde, 25(2).
FRAWLEY A, HICKEY J, WEAVER C, WILLIAMS J, SZAKMANY T. Introduzindo
uma nova política de sedação num hospital geral distrital de grande porte: antes e depois da análise de coorte. Feb, 23;51(1), p.4–10. 2019.
LIMA E SILVA, S et al. Sedação para procedimentos em crianças e adolescentes: uma proposta a partir do sistema GRADE. Rev Med Minas Gerais, 27(3). 2017.
LUCAS SS, NASR VG, NG AJ, JOE C, BOND M, DINARDO JA. Pediatric Cardiac
Intensive Care Society 2014 consensus statement: pharmacotherapies in cardiac critical care: sedation, analgesia and muscle relaxant. Pediatr Crit Care Med., 17, S3-15. 2016.
MAISON O, TARDY C, OFFREY J, BOSELLI E, PIRIOU V, PARAT S, et al.
Compliance with sedation analgesia protocols: Do clinical pharmacists have an impact? Journal of Clinical Pharmacy and Therapeutics, 29; 45(1), p.59-64, Oct. 2019.
MCGRANE S, PANDHARIPANDE PP. Sedation in the intensive care unit. Minerva Anestesiol. 78, p.369-80. 2012.
NAMIGAR T, SERAP K, ESRA AT, ÖZGÜL O, CAN O, , AYSEL AK, ACHMET A.
Correlação entre a escala de sedação de Ramsay, escala de sedação-agitação de Richmond e escala de sedação-agitação de Riker durante sedação com midazolam- remifentanil. Rev Bras Anestesiol, 67(4), p. 347-354. 2017.
RAMALHO CE et al, Sedation and analgesia for procedures in the pediatricemergency room. J Pediatr (Rio J), 93(s1), p. 2-18. 2017.
RASHIDI M, MOLAVYNEJAD S, JAVADI N, ADINEH M, SHARHANI A,
POURSANGBUR T. The effect of using Richmond agitation and sedation scale on hospital stay, ventilator dependence, and mortality rate in ICU inpatients: A randomised clinical trial. J Res Nurs, 25(8), p. 734-46. 2020.
SHI et al. Effect of midazolam on delirium in critically ill patients: a propensity score analysis. Journal of International Medical Research. 50(4) 1–10. 2022.
SLOOTER AJ, VAN DE LEUR RR, ZAAL IJ. Delirium em pacientes criticamente enfermos. Handb Clin Neurol,p.449-466. 2017.
STEPHENS RJ, DETTMER MR, ROBERTS BW, ABLORDEPPEY E, FOWLER SA,
KOLLEF MH, et al. Practice patterns and outcomes associated with early sedation depth in mechanically ventilated patients: A systematic review and meta-analysis. Crit Care Med, 46(3), p. 471-9. 2018.
TALSI O, KIISKI BERGGREN R, JOHANSSON G, WINSO O. A national survey on
routines regarding sedation in Swedish intensive care units. Ups J Med Sci. 124(3), p.199–202. 2019.
TEIXEIRA, C. High mortality in Brazilian intensive care units can be a problem of laws rather than a technical one: focus on sedation practices. Crit Care Sci., 35(2), p.230-232. 2023.
VARNDELL, W., ELLIOTT, D., FRY, M. The validity, reliability, responsiveness and applicability of observation sedation-scoring instruments for use with adult patients in the emergency department: a systematic literature review. Australasian Emergency Nursing Journal, v. 18, n. 1, p. 1-23. 2015.
