Impact of nursing experience on cancellation of light sedation for mechanically ventilated patients in a setting of 1 : 2 nurse-patient ratio

Background
Caring for lightly sedated intubated patients increases caregiver workload. Therefore, providing light sedation to intubated patients may depend on nursing experience. We retrospectively investigated the association between conversion from light to deep sedation and nursing experience in intensive care units (ICUs) with a 1 : 2 nurse-to-patient ratio.

Methods
It was a historical cohort study performed in ICUs in a university hospital. One hundred and eighty-four patients requiring more than 72 hours of mechanical ventilation after ICU admission were analyzed. To avoid channeling bias, propensity score analysis was used to generate a set of matched cases (managed by trainee nurses) and controls (managed by experienced nurses), yielding 72 matched patient pairs. Primary (change from light to deep sedation) and secondary outcomes (sedation level after light sedation cancelation, ICU stay, and intubation duration) were compared.

Results
Conversion from light to deep sedation was equally preferred by trainee nurses, with conversion rates of > 70% regardless of matching procedure (P = 0.663). Deeper sedation was preferred by experienced nurses (P = 0.025). Management by experienced nurses significantly prolonged ICU stay (16.3 vs. 21.4, P = 0.033). Additional multivariable logistic regression revealed that visual disturbance (OR [95% CI] = 4.3 [1.4–13.3], P = 0.012), Richmond Agitation-Sedation Scale (RASS) (OR [95% CI] = 2.2 [1.7–2.9], P < 0.0001), and dexmedetomidine dose 48 h post-ICU admission (OR [95% CI] = 0.81 [0.69–0.96], P = 0.016) were independently associated with giving up light sedation.

Conclusions
Conversion from light to deep sedation was preferred in > 70% of mechanically ventilated patients in ICUs with a 1 : 2 nurse-to-patient ratio. Rates of sedation level changes for managing mechanically ventilated patients were similar between trainee and experienced nurses. However, experienced nurses preferred significantly deeper sedation than trainee nurses.