Running head: SEDATION VACATION IN THE PREVENTION OF VAP Daily Sedation Vacation in the Prevention of Ventilator-Associated Pneumonia Shannon Taylor Walden University Essentials of Evidence-Based Practice NURS-6052N-19 October 2, 2016

Sedation Vacation in the Prevention of VAP 1 Abstract Interventions to prevent ventilator-associated pneumonia (VAP) has been a topic of concern for years. The proper interventions, such as daily sedation vacations (DSVs), may lead to a faster recovery time, shorter length of stay (LOS) in hospitals, early extubation from the ventilator, prevent the occurrence of VAP, and decrease medical costs. This study analyzes the appropriate interventions that have been proven to reduce the occurrence of VAP. This paper seeks to answer the research question; will a daily sedation vacation decrease the probability of acquiring VAP in mechanically ventilated patients? The purpose of this paper is to analyze the literature, determine what is currently known about this topic, identify holes in the research, and provide a literature review on the prevention of VAP.

Sedation Vacation in the Prevention of VAP 2 Introduction This study aims to focus on the prevention of VAP by providing the appropriate interventions, such as a daily sedation vacation. The majority of patients placed on a mechanical ventilator, for various reasons, are administered a sedative to promote comfort and to reduce anxiety and agitation while on the ventilator. The physician determines the level of sedation and is monitored by the nurse. The Richmond Agitation-Sedation Scale and the Sedation-Agitation Scale are most frequently used in facilities to determine the level of sedation. Based on those scores, the sedative medication may be titrated to achieve the optimal level of sedation. Each patient's level of sedation requirement will be different due to weight, current illness and treatment plan, co-morbidities, and medication history. Although sedation assists in decreasing anxiety and agitation of the patient, it can also produce undesirable side effects. Sedation medications can cause lengthy hospital stays, delirium, and extended days of mechanical ventilation. As stated in the previous paper, ventilator-associated pneumonia is one of the leading causes of death in critically ill patients in intensive care units (ICU). It is the second most prevalent nosocomial infection. To decrease these statistics, learning more about the interventions that will aid in the deterrence of VAP is imperative. One intervention, in particular, is of interest to this study, a daily sedation vacation. A sedation vacation consists of a daily interruption from sedative medications. Daily sedation vacations allow for assessment of the patient’s readiness to be extubated, and early extubation has been shown to decrease the incidence of VAP [Mun14].