机械通风重症患者每日镇静中断,用镇静方案照顾:一个随机对照试验
Sangeeta Mehta1, Lisa Burry, Deborah Cook
1Division of Critical Care, Department of Medicine and Interdepartmental Mount Sinai Hospital and University of Toronto, Toronto, Canada. geeta.mehta@utoronto.ca
JAMA
|November 27, 2012
概括
添加每日镇静中断协议化镇静并没有减少机械呼吸或重症监护室停留时间. 这一策略还增加了镇静剂和阿片类药物剂量以及护士的工作量.
科学领域:
- 临界护理医学 临界护理医学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 协议化镇静和日常镇静中断是管理机械呼吸和重症监护室 (ICU) 停留时间的关键策略.
- 假设将这些镇静管理技术结合起来可以提高患者的治疗结果.
研究的目的:
- 为了比较单独的protocolized镇静疗法的疗效与结合每日镇静中断的protocolized镇静疗法的疗效,在危急病的机械通风患者中.
主要方法:
- 一项随机对照试验,涉及16个ICU的430名成年患者.
- 患者接受协议化镇静或协议化镇静每日间断,护士定位输液以达到轻度镇静.
- 关键结局是成功输出管的时间;次要结局包括ICU/住院,镇静剂剂量,妄想和工作量.
主要成果:
- 两组之间成功输出管的时间 (中位数为7天) 没有显著差异.
- 住院时间和住院时间也差不多.
- 每日中断组显示,镇静剂和阿片类药物剂量增加,护士工作量增加 (VAS得分).
- 狂妄症的发生率和非故意的内管切除并没有显著差异.
结论:
- 在机械通风的成年人中,在协议化镇静剂中增加每日镇静中断并没有缩短机械通风的持续时间或ICU停留时间.
- 这些发现表明,这种综合方法可能不会提供额外的好处,而且可能会增加药物使用和工作量.
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