A greater analgesia, sedation, delirium order set quality score is associated with a decreased duration of mechanical ventilation in cardiovascular surgery patients

Christopher R. Dale, Christopher L. Bryson, Vincent S. Fan, Charles Maynard, Norbert Yanez, Miriam Treggiari

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

OBJECTIVE: Protocols and order sets for the delivery of analgesia, sedation, and delirium care of the critically ill, mechanically ventilated patient have been shown to improve outcomes but are not uniform in hospitals across geographic areas. The extent to which greater order set quality is associated with improved patient outcomes is not known. We hypothesized that cardiac surgery patients cared for at hospitals with a greater analgesia, sedation, and delirium order set quality score (more guideline-concordant order sets) would have a shorter average duration of mechanical ventilation. DESIGN: Retrospective cohort study. SETTING: All Washington State non-federal hospitals providing cardiac surgery. PATIENTS: All mechanically ventilated cardiac surgery patients from January 1, 2008, until September 30, 2011. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We created a multivariable linear regression model to assess the relationship between a hospital's pain, agitation and delirium order set quality, as assessed by an expert-validated order set quality score, and the average duration of mechanical ventilation of its cardiac surgery patients, independent of other hospital and patient factors. A total of 19,561 patients underwent cardiac surgery at 16 Washington state hospitals during the study period. The order set quality scores ranged from 4 to 19 with a mean of 11.8 ± 4.5. The mean duration of mechanical ventilation was 27.0 ± 196.6 hours. In the multivariable model, independent of other patient and hospital factors, a 1-point increase in the order set quality score was associated with a 3.3 ± 0.9 hour (p <0.01) decrease in average duration of mechanical ventilation. CONCLUSIONS: Cardiac surgery hospitals with more guideline-adherent analgesia, sedation, and delirium order sets have patients with shorter mean durations of mechanical ventilation than hospitals with lower order set quality scores.

Original languageEnglish (US)
Pages (from-to)2610-2617
Number of pages8
JournalCritical Care Medicine
Volume41
Issue number11
DOIs
StatePublished - Nov 2013
Externally publishedYes

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Delirium
Artificial Respiration
Analgesia
Thoracic Surgery
Linear Models
Guidelines
State Hospitals
Critical Illness
Cohort Studies
Retrospective Studies
Pain

Keywords

  • Cardiac surgery
  • Intensive care
  • Mechanical ventilation
  • Order set
  • Outcomes
  • Sedation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

A greater analgesia, sedation, delirium order set quality score is associated with a decreased duration of mechanical ventilation in cardiovascular surgery patients. / Dale, Christopher R.; Bryson, Christopher L.; Fan, Vincent S.; Maynard, Charles; Yanez, Norbert; Treggiari, Miriam.

In: Critical Care Medicine, Vol. 41, No. 11, 11.2013, p. 2610-2617.

Research output: Contribution to journalArticle

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