Letting the Patient Decide: A Case Report of Self-Administered Sedation During Mechanical Ventilation.
Breanna Hetland, Sarah Maryon Hayes, Debra Skaar and 3 others
PMID 29437074WHAT IT FOUND
One mechanically ventilated ICU patient self-administered dexmedetomidine for anxiety while also receiving hydromorphone and midazolam.
She said it helped her concentrate and relax. This is one person’s experience, not evidence that the method works.
Key findings
01The case patient self-administered dexmedetomidine boluses when anxious or wanting relaxation, while nurses adjusted her basal infusion and gave hydromorphone and midazolam as needed.
02Her anxiety score fell from 25 mm to 15 mm on a 100-mm scale, but she also received hydromorphone and midazolam during the protocol.
03She rated self-administering the medication, controlling anxiety, and level of relaxation as very satisfied and said it helped her concentrate and relax.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a case report of one patient, not a controlled comparison of PST-DEX with usual care. PD received dexmedetomidine together with hydromorphone and midazolam, so the contribution of any one medicine cannot be separated. Anxiety was measured on day 1 and day 2 during the protocol, and day 3 assessments were not obtained before extubation. The satisfaction survey was investigator-developed and completed by one patient after extubation. The parent pilot trial details are reported elsewhere, and this article does not provide full trial outcomes. The trial excluded hemodynamically unstable patients, so safety in unstable patients is not shown.
The easy way to misread this
Do not conclude that self-administered dexmedetomidine reduced this patient’s anxiety or made extubation possible. She also received hydromorphone and midazolam, and this is one case report, not a controlled test of the sedation method.