Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study. Issue 6 (September 2020)

• Record Type: Journal Article
• Authors: Cinotti, Raphaël; Besnard, Noémie; Desmedt, Luc; Floch, Ronan Le; Perrot, Pierre; Bekara, Farid; Klouche, Kada; Larcher, Romaric; Mahé, Pierre-Joachim; Frasca, Denis; Asehnoune, Karim; Jung, Boris; Roquilly, Antoine
• Is Part Of: Burns. Volume 46:Issue 6(2020)
• Page Start: 1310
• Page End: 1317
• Publication Date: 2020-09
• Subjects: Sedation -- Analgesia -- Mechanical ventilation -- Weaning; Burns and scalds -- Periodicals; 617.11
• DOI: 10.1016/j.burns.2020.02.009
• Languages: English
• ISSNs: 0305-4179

Abstract

Highlights: Critically burn patients usually undergo prolonged and important doses of hypnotics and opioids. Analgesia and sedation can be titrated according to clinical scales in burn patients. Analgesia-sedation titration failed to decrease mechanical ventilation duration. Abstract: Background: Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients. Methods: We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24 h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU. Results: Eighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%–38%] and median ABSI was 7 [5–9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2–24] vs. 6 days [2–17] (P = 0.3) and 17 days [4–32] vs. 8 days [3–23] (P = 0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2–24] in the Intervention phase (P = 0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P = 0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P = 0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P = 0.6). Conclusion: Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation.