Resuscitating the Ventilator Rounding Tool: Sedation Impacts in the Medical Surgical Trauma ICU

Introduction: The Ventilator Rounding Tool (VRT) is an evidence-based practice tool promoting ICU liberation by addressing pain, sedation & delirium. The COVID-19 pandemic created a setback for care with many patients needing deep sedation, leading nurses to learning the misconception that deep sedation is “standard of care.” The aim of this study was to evaluate outcomes pre and post re-introduction of the VRT and nursing education.


Methods: Adult patients in the Medical/Surgical/Trauma ICU (MSTICU) who required mechanical ventilation were included. Baseline data from October 2023-July 2024 was compared to post-intervention from August 2024-June 2025. In our MSTICU, nurses utilize an institution specific sedation algorithm for titrating sedatives. The intervention of this study was pharmacist-led education on the institution sedation algorithms with a focus on light sedation in concordance with a multidisciplinary team plan to reinforce the VRT. The primary outcome was total duration of continuous infusion (CI) sedatives (propofol and/or fentanyl). Additional outcomes included ICU length of stay (LOS), ventilator days, amount of as needed sedative administration, & the incidence of delirium.


Results: The study included 573 patients, 239 in the pre-intervention group and 334 in the post intervention group. The median duration of CI sedatives was 32 (14 -71) hours in the pre-intervention group vs. 25 (11 – 54.3) hours in the post intervention group (p=0.037). The median amount of as-needed sedative (fentanyl & hydromorphone) was 120 mg (45 –262.5) mg in morphine equivalent dose (MED) in the pre-intervention group vs. 105 (45 -232.5) mg in MED in the post intervention group (p=0.53). Median number of ventilator days was 1.8 days in the pre-intervention group vs. 1.63 days in the post intervention group (p=0.095). Median ICU LOS was 5 (3 –7) days in the pre group vs. 4 (3 – 7) days in the post group (p=0.027). The incidence of delirium was 62.3% in the pre group vs. 53.3% in the post group (p=0.031).


Conclusions: Re-engaging nurses with education on promoting light sedation & the VRT led to significantly reduced time on continuous sedatives & ICU LOS. It was also associated with lower rates of delirium. Study results support the positive impact of multidisciplinary teamwork on patient outcomes.