Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study

• Published in: Burns Vol. 46; no. 6; pp. 1310 - 1317
• Main Authors: Cinotti, Raphaël, Besnard, Noémie, Desmedt, Luc, Floch, Ronan Le, Perrot, Pierre, Bekara, Farid, Klouche, Kada, Larcher, Romaric, Mahé, Pierre-Joachim, Frasca, Denis, Asehnoune, Karim, Jung, Boris, Roquilly, Antoine
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-09-2020; Elsevier
• Subjects: Analgesia; Human health and pathology; Life Sciences; Mechanical ventilation; Sedation; Tissues and Organs; Weaning; Analgesia; Sedation; Weaning; Mechanical ventilation
• ISSN: 0305-4179; 1879-1409
• DOI: 10.1016/j.burns.2020.02.009

•Critically burn patients usually undergo prolonged and important doses of hypnotics and opioids.•Analgesia and sedation can be titrated according to clinical scales in burn patients.•Analgesia-sedation titration failed to decrease mechanical ventilation duration.
Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients.
We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU.
Eighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%–38%] and median ABSI was 7 [5–9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2–24] vs. 6 days [2–17] (P=0.3) and 17 days [4–32] vs. 8 days [3–23] (P=0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2–24] in the Intervention phase (P=0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P=0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P=0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P=0.6).
Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilation.