Client Says: PLEASE ADD THIS TO THE ARTICLES AND USE IT FOR THE RESEARCH TOO. I REALLY HOPE YOU GUYS ARE USING MY REFERNCES AND RESEARCH FOT HIS CAPSTONE.  ILL KEEP POSTING EXTRA REFERENCES THAT CAN HELP OUT FOR MY PAPER.  Dotson, B. (2010). Daily interruption of sedation in patients treated with mechanical ventilation. American Journal Of Health-System Pharmacy, 67(12), 1002-1006 5p. doi:10.2146/ajhp090134  Authors:Dotson B.Affiliation:Harper University Hospital, Detroit, MI 48201, USA. .Source:American Journal of Health-System Pharmacy (AM J HEALTH SYST PHARM AJHP), 6/15/2010; 67(12): 1002-1006. (5p).Publication Type:Journal Article.Language:English.Major Subjects:Hypnotics and Sedatives -- Administration and Dosage  Respiration, Artificial  Time.Minor Subjects:Adverse Drug Event; Hypnotics and Sedatives -- Standards; Sedation -- Methods.Abstract:PURPOSE: The evidence evaluating daily interruption of sedation (DIS) in mechanically ventilated patients, the benefits of this intervention, and the barriers to its incorporation into clinical practice are reviewed. SUMMARY: Recent epidemiologic studies have identified a high prevalence of oversedation in the intensive care unit (ICU). The practice of DIS, which involves withholding all sedative and analgesic medications until patients are awake on a daily basis, can limit excessive sedation. DIS has been shown to reduce the duration of mechanical ventilation and length of ICU stay, lessen the number of neurodiagnostic tests to assess for changes in mental status, decrease the frequency of complications associated with critical illness, and reduce the total dose of benzodiazepines and opiates administered. Although recent studies support the use of DIS, it remains underutilized in clinical practice and additional trials may be needed before this intervention will gain widespread acceptance. Barriers to the use of DIS include a lack of nursing acceptance and concerns regarding patient removal of invasive devices, patient discomfort, respiratory compromise, and withdrawal syndromes. Some clinicians are also concerned about the possibility of long-term psychological sequelae and the risk of myocardial ischemia during DIS in patients with coronary risk factors. CONCLUSION: DIS limits oversedation in the ICU without compromising patient comfort or safety and should be incorporated into the routine care of mechanically ventilated patients. Clinicians should be aware of the numerous barriers that prevent the use of DIS and address these at their institution to increase its use..Journal Subset:Biomedical; Blind Peer Reviewed; Peer Reviewed; USA.Special Interest:Pain and Pain Management.ISSN:1079-2082.MEDLINE Info:PMID: 20516470 NLM UID: 9503023.Entry Date:20100625.Revision Date:20150711.DOI:http://dx.doi.org.lopesalum.idm.oclc.org/10.2146/ajhp090134 .Accession Number:105030056. HERE IS ANOTHER ONE  Sedwick, M. B., Lance-Smith, M., Reeder, S. J., & Nardi, J. (2012). Using Evidence-Based Practice to Prevent Ventilator-Associated Pneumonia. Critical Care Nurse, 32(4), 41-51 11p. doi:10.4037/ccn2012964  Abstract:BACKGROUND Strategies are needed to help prevent ventilator-associated pneumonia. OBJECTIVE To develop a ventilator bundle and care practices for nurses in critical care units to reduce the rate of ventilator- associated pneumonia. METHOD The ventilator bundle developed by the Institute for Healthcare Improvement was expanded to include protocols for mouth care and hand washing, head-of- bed alarms, subglottic suctioning, and use of an electronic compliance feedback tool. Compliance audits were used to provide immediate electronic feedback. RESULTS Adherence to practices included in the bundle increased. Compliance rates were greater than 98% for prophylaxis for peptic ulcer disease and deep-vein thrombosis, interruption of sedation, and elevation of the head of the bed. The compliance rate for the oral care protocol increased from 76% to 96.8%. Readiness for extubation reached at least 92.4%. Rates of ventilator-associated pneumonia decreased from 9.47 to 1.9 cases per 1000 ventilator days. The decrease in rates produced an estimated savings of approximately $1.5 million. CONCLUSION Strict adherence to bundled practices for preventing ventilator-associated pneumonia, enhanced accountability for initiating protocols, use of a feedback system, and interdisciplinary collaboration improved patients' outcomes and produced marked savings in