• Linda L Chlan, Debra J Skaar, Mary F Tracy, Sarah M Hayes, Breanna D Hetland, Kay Savik, and Craig R Weinert.
• Linda L. Chlan is associate dean for nursing research, Mayo Clinic, Rochester, Minnesota. Debra J. Skaar is an associate professor, College of Pharmacy, Kay Savik is a senior statistician, School of Nursing (retired), and Craig R. Weinert is an associate professor, School of Medicine, University of Minnesota, Minneapolis, Minnesota. Mary F. Tracy was a critical care clinical nurse specialist, University of Minnesota Medical Center, Minneapolis, Minnesota. Sarah M. Hayes is a pharmacy resident, North Memorial Medical Center, Minneapolis, Minnesota. Breanna D. Hetland is a postdoctoral fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Chlan.Linda@mayo.edu.
• Am. J. Crit. Care. 2017 Jul 1; 26 (4): 288-296.

BackgroundSafety and acceptability of sedative self-administration by patients receiving mechanical ventilation is unknown.ObjectivesTo determine if self-administration of dexmedetomidine by patients is safe and acceptable for self-management of anxiety during ventilatory support.MethodsIn a pilot trial in 3 intensive care units, 17 intubated patients were randomly assigned to dexmedetomidine and 20 to usual care. Dexmedetomidine was administered via standard pumps for patient-controlled analgesia, with a basal infusion (0.1-0.7 μg/kg per hour) titrated by the number of patient-triggered doses (0.25 μg/kg per dose). Safety goals were heart rate greater than 40/min, systolic blood pressure greater than 80 mm Hg, and diastolic blood pressure greater than 50 mm Hg. Acceptability was based on patients' self-reported satisfaction and ability to administer the sedative. A 100-mm visual analog scale was used daily to assess patients' anxiety.ResultsThe sample was 59% male and 89% white. Mean values were age, 50.6 years; score on the Acute Physiology and Chronic Health Evaluation, 60.1; and protocol duration, 3.4 days. Five dexmedetomidine patients had blood pressure and/or heart rate lower than safety parameters, necessitating short-term treatment. Nurses' adherence to reporting of safety parameters was 100%; adherence to the dexmedetomidine titration algorithm was 73%. Overall baseline anxiety score was 38.4 and did not change significantly (βday = 2.1; SE, 2.5; P = .40). Most dexmedetomidine patients (92%) were satisfied or very satisfied with their ability to self-administer medication.ConclusionsFor select patients, self-administration of dexmedetomidine is safe and acceptable.©2017 American Association of Critical-Care Nurses.

26 keywords...

hide…