What does a lower sedative total after an ICU medication change tell us?
When a hospital chart shows a lower sedative total the day after a drug was added, the timing is useful. Several factors can account for the difference between the two days.
What the study observed
Rayner and colleagues reviewed 20 intensive-care patients who received dexmedetomidine for severe alcohol withdrawal. In patients with the necessary dosing data, benzodiazepine dosing fell by 61.5% in the first 24 hours after initiation compared with the preceding 24 hours. Withdrawal scores also fell in the smaller group with score data. The study reported a serious rhythm event in one patient.
Questions for an individual record
This was a retrospective before-and-after comparison without a concurrent control group. Changes in the underlying illness, other treatments or how staff recorded symptoms could affect the comparison. To evaluate a particular admission, match each administered dose to the recorded symptoms, monitoring and other interventions. The chart and the study provide different kinds of evidence.
