THE EFFECTS OF THE LEVEL OF SEDATION ON THE RECOVERY OF PATIENTS UNDERGOING INVASIVE MECHANICAL VENTILATION IN THE INTENSIVE CARE UNIT

Abstract

The Intensive Care Unit (ICU) is a highly complex environment for the intensive care of critically ill patients. Most of the patients admitted to this sector require ventilatory support techniques, and one of the main measures adopted is invasive mechanical ventilation (IMV), through orotracheal intubation (OTI). Allied to OTI, a fundamental strategy aimed at bringing greater comfort and stability to the patient is sedation, which, although it avoids the process of unplanned extubation, can prolong the period of stay on mechanical ventilation, the length of hospitalization, as well as undoubtedly increasing the patient's mortality rate in the ICU setting. In view of the high and sometimes indiscriminate use of sedatives in the intensive care setting, the ventilatory needs of hospitalized patients and the pulmonary damage resulting from the incorrect application of sedative drugs, which can increase the risk of death, the importance of this study is justified, with the aim of analyzing the impact of the degree of sedation, through the joint interpretation of the RASS scale and the SOFA score, on the recovery process of patients under invasive mechanical ventilation in the ICU setting. To prepare the project, a literature review was carried out using original articles published in English and Portuguese over the last 22 years in the main reference databases such as SciELO, PubMed and MedLine, in order to ensure greater reliability of the study and the data presented. A thorough analysis of the projects showed that patients who underwent sedation in IMV, using the minimum dose necessary to ensure clinical stability (RASS -1 and -2), had satisfactory ventilator weaning, faster recovery and shorter hospital stays. On the other hand, patients who underwent an intermediate degree of sedation (RASS -3) required a longer hospital stay and had an increased risk of morbidity and mortality. Patients who received deep sedation (RASS -4 and -5) had a high risk of staying in hospital, a higher risk of acquiring hospital-acquired infections and ventilator-associated pneumonia, as well as death rates of approximately 60% of hospitalized patients. Furthermore, it was noted that the longer the length of stay in intensive care, the worse the prognosis according to the SOFA score, with patients tending to develop significant organ dysfunction over the course of their hospital stay. It was therefore possible to conclude that pulmonary function was reduced in patients undergoing IMV with a high degree of sedation, in direct proportion to the length of hospital stay, which considerably compromised the return to spontaneous ventilation. Furthermore, prolonged sedation has been shown to be one of the main risk factors for increased morbidity and mortality rates in high-complexity services, as well as contributing to organ dysfunction. Therefore, it is essential to opt for the lowest level of sedation capable of providing stability to the critical patient, which not only guarantees greater safety, but also improves recovery rates in the intensive care environment.