No-sedation during mechanical ventilation: impact on patient's consciousness, nursing workload and costs

Background: Evidence is growing that less or no-sedation is possible and beneficial for patients during mechanical ventilation.

Aim: To investigate if there was a difference in patient consciousness and nursing workload comparing a group of patients receiving no-sedation with a group of sedated patients with daily wake up, and also to estimate economic consequences of a no-sedation strategy.

Design and methods: Data were collected during a prospective trial of 140 mechanically ventilated patients randomized to either no-sedation or to sedation with daily wake up. From day 1 to 7 in the intensive care unit (ICU), patients were Richmond Agitation and Sedation Scale (RASS) scored, nursing workload was measured with the Nursing Care Recording System (NCR11) and nurse's self-assessment of workload was reported on a Numeric Rating Scale from 1 (low) to 10 (high).

Results: Patients from the no-sedation group had a median RASS score of -0·029 compared with -2 in the sedated group (P < 0·00001). The NCR11 scores were higher in the sedated group compared with the no-sedation group: 19·054 versus 17·05 (P = 0·00001). The nurses self-reported workload was the same in both groups (P = 0·085). Because of a shorter ICU stay and shorter hospital length of stay in the no-sedation group, we estimated that there will be no cost benefit with the use of sedation and a higher patient to nurse ratio.

Conclusion: Patients receiving no-sedation were more awake with a RASS score close to zero, compared with patients receiving sedation and daily wake up. Nurses reported no difference in self-assessed workload between the no-sedation and sedated group of patients.

Relevance to clinical practice: Patients receiving no-sedation are more awake during their stay in ICU. There might be a potential economical saving with the use of a 1:1 nurse-patient ratio and no-sedation compared with sedation and a 1:2 nurse-patient ratio.