Abstract 1 - Topics in Intensive Care

The implementation of a protocol ‘Weanscreen’ will lead to lower sedation levels, more
frequent sedation stops and proper positioning in the ICU.
Monique le Grand, Christiaan Theunisse, ventilation practitioners en Huibert Ponssen, intensivist,
Albert Schweitzer hospital, Dordrecht, Netherlands.
Introduction:
Literature shows that daily sedation stops and proper use of sedating medicins will lead to a reduction
of ventilator days, 30 degrees lifting shows in some studies a reduction of the incidence of VAP.
Methods:
In the past year every patient was screened in the morning as described in a protocol “weanscreen” :
this bundle consisted of sedation stops, monitoring delirium CAM-score, 30 degrees upright position,
Rapid Shallow Breathing Index ( RSBI ) en spontaneous weaning trials.
Every nurse and doctor received an extensive education session and a plastified sheat describing the
bundle elements was attached to every bed.
The implementation was coordinated by 2 nurse practitioners and an intensivist.
299 measurements (N= 103) showed that the patient group before and after the implementation were
compatible. The ‘after group’ did have a higher APACHE 2 score.
Results:
Before implementation 41 % of the patients received a sedation stop, after implementation 70 %.
Before 50 % of our patients did have a 30 degrees position. After implementation 78 %. The depth of
sedation was significatly reduced ( RASS) : figure and table 1.
Conclusion:
Implementing a ventilation bundle ‘ Weanscreen’ leads to an increase of sedation stops, a reduction of
the RASS score and more patient in a proper position.
Figure 1:
Table 1:
Table 1: RASS‐score Before After P
RASS (gem ± s.d.) ‐2,9 ± 1,9 ‐1,2± 1,6