EFFECT OF DAILY SEDATION INTERRUPTION PROTOCOL ON MECHANICAL VENTILATED PATIENTS OUTCOMES AT NABLUS CITY, PALESTINE: A RETROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Intravenous sedation and analgesia are a key component of the management of patients on mechanical ventilation (MV).excellent sedation and analgesia are required for critically ill patients on mechanical ventilation and good outcome However, there is evidence that cessation of these drugs on a daily basis is related with better outcomes in patients who are mechanically ventilated. Objective: To compare the effects of the Daily Sedation Interruption (DSI) protocol versus usual sedation care on the duration of mechanical ventilation (MV), length of stay (LOS) in the ICU and hospital , hospital and ICU mortality, drug requirement and time to extubation in mechanically ventilated adult patients. Methods: A quantitative, retrospective observational study design was used. The study population included adult patients (≥18 years) admitted to the medical and surgical intensive care units at An-Najah National University Hospital (NNUH) who required invasive mechanical ventilation for more than 24 hours. Participants were selected using a convenience sampling method, with 30 patients from each group matched based on clinical characteristics such as age, sex, and diagnosis. Data were extracted from patients’ medical records covering the period from 2017 to 2020. Results: No statistically significant differences were observed between the DSI and usual sedation groups in the evaluated clinical outcomes. The duration of mechanical ventilation was 6.86 days in the DSI group compared with 5.53 days in the usual sedation group (p = 0.973). ICU length of stay was comparable between groups (9.23 vs. 8.47 days; p = 0.077). Although ICU mortality was lower in the DSI group compared with usual sedation care (41% vs. 59%), the difference was not statistically significant (p = 0.081). The tracheostomy rate was also lower in the DSI group (37.5% vs. 62.5%), without statistical significance (p = 0.478). Hospital length of stay showed a trend toward reduction in the DSI group (9.43 vs. 13.03 days), although this difference did not reach statistical significance (p = 0.077). Conclusion: In this cohort of mechanically ventilated critically ill adults, implementation of a DSI protocol was not associated with statistically significant improvements in mechanical ventilation duration, ICU length of stay, mortality, or tracheostomy rates compared with usual sedation care. However, the observed trends toward lower mortality and reduced tracheostomy rates suggest potential clinical benefits that warrant further investigation. Larger prospective multicenter studies with standardized sedation and weaning protocols are needed to identify patients most likely to benefit from DSI and to clarify its role within contemporary ICU sedation strategies.