The effect of daily sedation interruption protocol on early incidence of ventilator‑associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation

Mehdi Shahabi, Hojatollah Yousefi, Ahmad Reza Yazdannik, Babak Alikiaii


Background: Ventilator-associated pneumonia (VAP) is a common side effect in patients who receive intravenous sedation infusion. In routine care, after starting sedation infusion for patients who receive mechanical ventilation, interruption of sedation starts without protocol. This study aimed to evaluate the effect of daily sedation vacation protocol on the incidence of VAP in mechanically ventilated patients.
Materials and Methods: In this clinical trial study, 80 patients with intravenous sedation infusion were selected and randomly allocated to intervention and control groups. In the intervention group, daily sedation vacation protocol and in the control group, routine sedation vacation was followed. Modified clinical pulmonary infection score questionnaire was completed before intervention and on the third, fourth, and fifth days after intervention. Data were analyzed by using repeated measures analysis of variance (ANOVA), Chi-square, and independent t-test.
Results: The results of this study showed that the incidence rate of VAP in the intervention and control groups was 0% versus 15% on the third day of intervention, 12.5% versus 50% on the fourth day, and 27.5% versus 55.3% on the fifth day of intervention in the intervention and control groups, respectively. The incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05).
Conclusions: The results of this study showed that in patients with intravenous sedation, infusion of a daily sedation vacation protocol may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to use this daily sedation vacation protocol.


Iran; ventilator-associated pneumonia; sedation; sedation vacation

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Marino P, Sutin K. The ICU Book. 3th ed. Philadelphia: Williams & Wilkins Pub.; 2007.

Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): A randomised controlled trial. Lancet 2008;371:126‑34.

Mofrad MN, Shiri H. Intensive Care in ICU. 13th ed. Tehran: Noor-Danesh pub. 2013.

Roy G. Interventions by critical care nurses reduce VAP. Dynamics 2007;18:28‑31.

Esperatti M, Ferrer M, Theessen A, Liapikou A, Valencia M, Saucedo LM, et al. Nosocomial pneumonia in the Intensive Care Unit acquired by mechanically ventilated versus nonventilated patients. Am J Respir Crit Care Med 2010;182:1533‑9.

Augustyn B. Ventilator‑associated pneumonia: Risk factors and

prevention. Crit Care Nurse 2007;27:32‑6.

Efrati S, Deutsch I, Antonelli M, Hockey PM, Rozenblum R, Gurman GM. Ventilator‑associated pneumonia: Current status and future recommendations. J Clin Monit Comput 2010;24:161‑8.

Arabnejad H, Mohammadbagheri M, Jonidi N, Ahmadinejad M. Tadrisi D, et al. Frequency of ventilator associated pneumonia. Iran J Infect Dis Trop Med 2011;16:47‑53.

Ranjbar H, Jafari S, Kamrani F, Alavi Majd H, Yaghmaei F, Asgari A. Effect of chlorhexidine gluconate oral rinse on preventing of late onset ventilator‑associated pneumonia and it’s interaction with severityof illness. Iran J Crit Care Nurse 2010;3:81‑6.

Seyedalshohadaee M, Rafii F, Haghani H, Arani FF. Evaluating the effect of mouth washing with chlorhexidine on the ventilator associated pneumonia. Iran J Nurs 2012;25:34‑44.

Khorvash F, Abbasi S, Meidani M, Dehdashti F, Ataei B. Comparison between pantoprazole and sucralfate in Ventilation Associated Pneumonia (VAP) in ICU admitted patients. Adv Biomed Res 2014;3:52. Available from: http:// [Last cited

on 2016 Jan 19].

Abbott CA, Dremsa T, Stewart DW, Mark DD, Swift CC. Adoption of a ventilator‑associated pneumonia clinical practice guideline. Worldviews Evid Based Nurs 2006;3:139‑52.

Rea‑Neto A, Youssef NC, Tuche F, Brunkhorst F, Ranieri VM, Reinhart K, et al. Diagnosis of ventilator‑associated pneumonia: A systematic review of the literature. Crit Care 2008;12:R56.

Bouadma L, Wolff M, Lucet JC. Ventilator‑associated pneumonia

and its prevention. Curr Opin Infect Dis 2012;25:395‑404.

Grap MJ, Munro CL, Hummel RS 3rd, Elswick RK Jr., McKinney JL, Sessler CN. Effect of backrest elevation on the development of ventilator‑associated pneumonia. Am J Crit Care 2005;14:325‑32.

O’Keefe‑McCarthy S, Santiago C, Lau G. Ventilator‑associated

pneumonia bundled strategies: An evidence‑based practice. Worldviews Evid Based Nurs 2008;5:193‑204.

Wip C, Napolitano L. Bundles to prevent ventilator‑associated

pneumonia: How valuable are they? Curr Opin Infect Dis 2009;22:159‑66.

Anifantaki S, Prinianakis G, Vitsaksaki E, Katsouli V, Mari S,

Symianakis A, et al. Daily interruption of sedative infusions in an adult medical‑surgical Intensive Care Unit: Randomized controlled trial. J Adv Nurs 2009;65:1054‑60.

Lauzier F, Ruest A, Cook D, Dodek P, Albert M, Shorr AF, et al. The value of pretest probability and modified clinical pulmonary infection score to diagnose ventilator‑associated pneumonia. J Crit Care 2008;23:50‑7.

Koenig SM, Truwit JD. Ventilator‑associated pneumonia: Diagnosis, treatment, and prevention. Clin Microbiol Rev 2006;19:637‑57.

Sabery M, Shiri H, Moradiance V, Taghadosi M, Gilasi H, Khamechian M. The frequency and risk factors for early‑onset ventilator‑associated pneumonia in Intensive Care Units of Kashan Shahid‑Beheshti hospital during 2009‑2010. Kashan Univ Med Sci J FEYZ 2013;16:560‑9.

Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O’Neal PV, Keane KA, et al. The richmond agitation‑sedation scale: Validity and reliability in adult Intensive Care Unit patients. Am J Respir Crit Care Med 2002;166:1338‑44.

Schweickert WD, Gehlbach BK, Pohlman AS, Hall JB, Kress JP. Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med 2004;32:1272‑6.

Kress JP, Gehlbach B, Lacy M, Pliskin N, Pohlman AS, Hall JB. The long‑term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med 2003;168:1457‑61.

Quenot JP, Ladoire S, Devoucoux F, Doise JM, Cailliod R, Cunin N, et al. Effect of a nurse‑implemented sedation protocol on the incidence of ventilator‑associated pneumonia. Crit Care Med 2007;35:2031‑6.

Smith S. The impact of nurses’ adherence to sedation vacations on ventilator associated pneumonia prevention. Nursing Dissertations, 2012. p. 33. Available from: http://www. context=nursing_diss. [Last accessed on 2016 Jun 08].

Schweickert WD, Kress JP. Strategies to optimize analgesia and sedation. Crit Care 2008;12 Suppl 3:S6.


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