This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The purpose of this study is to determine the affect of sedative practices in short-term patient outcome and long-term mental health. The majority of mechanically ventilated critical care patients experience anxiety, fear, discomfort, or frank pain. This may be caused by being in an unfamiliar environment, severe illness, prolonged immobility, sleep deprivation, delirium, or indwelling catheters. These feelings may lead to patient agitation and subsequent danger of self-extubation, removal of vital lines and tubes, and patient-ventilator complications. Some of these complications may lead to increased mortality while others may result in significant morbidity. Because of these concerns, there is a tendency to oversedate patients. Recently, certain methods of sedation have been associated with decreased time of mechanical ventilation and better overall outcomes. Research has shown that patients receiving continuous sedation had longer mechanical ventilation times and higher extubation failure rates compared to patients who received sedatives given by intermittent intravenous boluses. Another research group found that patients who are awoken once daily and asked to complete simple tasks such as hand grasping and following an observer with their eyes, also have shorter lengths of mechanical ventilation times. Although both of these methods have been shown to be superior to the traditional treatment, these two methods have not been compared to each other. In addition, delirium is a frequent occurrence in patients who are mechanically ventilated. The presence of delirium is associated with an increased risk for major complications such as cardiac arrest and longer length of stay in the intensive care unit. Therefore it is important to understand in impact of these two sedative regimens on the frequency of delirium. Patients who meet entry criteria and consent (or have a legal representative consent) to the study will be randomized to receive one of the two sedation methods. Patients in both groups will be evaluated twice daily whole intubated and on mechanical ventilation. Subsequently, both groups will be assessed prior to hospital discharge and at 6 months follow-up. Each patient will also receive a daily evaluation to determine level of sedation and agitation. Finally, blood samples will be taken for determination of the pharmacokinetics of sedative drugs. A second phase of the investigation will include the administration of quality of life and post-traumatic stress questionnaires to determine if one ventilation method is superior to the other in terms of overall mental health.
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