Optimizing Sedation Management: Effects on Opioid Use and Duration of Mechanical Ventilation in ARDS

BACKGROUND AND OBJECTIVES: Our goal was to reduce the days of mechanical ventilation by 25% from 173 to 130 h without adversely impacting the number of self-extubations. METHODS: Data for the "Define" phase of the DMAIC approach were obtained through meetings with stakeholders to identify potential gaps in care. The study included patients with acute respiratory distress syndrome (ARDS) mechanically ventilated in the medical ICU. We identified nursing knowledge of the Richmond Agitation-Sedation Scale (RASS) scoring and identification of appropriate times for ventilator titration as key factors for intervention. We implemented educational interventions including structured in-person and self-study materials, embedded educational posters, and follow-up assessments to assess learning outcomes. Post-intervention patient data were assessed after the interventions. RESULTS: Mechanical ventilation duration decreased from 173 to 126 h, resulting in a 27% nominal reduction and meeting our pre-specified target. There was no increase in the balancing measure of self-extubations. CONCLUSION: Targeted interventions focusing on reducing excessive sedation in mechanically ventilated patients with ARDS may reduce duration of mechanical ventilation.