对重症监护室中药理学睡眠促进方式的快速系统审查
Mojdeh S Heavner1, Patricia R Louzon2, Emily F Gorman3
1Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
Journal of intensive care medicine
|July 5, 2023
概括
药理干预措施,如德克斯梅德托米丁和黑激素激动剂,在改善严重病情的成年人睡眠方面显示出混合的结果. 目前的证据不支持它们在重症监护室 (ICU) 的常规使用.
科学领域:
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
- 睡眠科学 睡眠科学
背景情况:
- 临床指南建议在重症监护中改善非药物睡眠.
- 在重症监护室 (ICU) 促进睡眠的药理学策略缺乏强有力的支持证据.
- 关于ICU患者基于药物的睡眠干预措施的有效性和必要性存在争议.
研究的目的:
- 系统地审查和综合有关药理学药物促进严重疾病成年人睡眠的证据.
- 评估用于改善ICU环境中的睡眠的各种药物类别的有效性和安全性.
主要方法:
- 在2022年10月之前,对Medline,Cochrane图书馆和Embase进行快速系统审查.
- 包括随机对照试验 (RCT) 和成年ICU中药理睡眠干预的前后队列研究.
- 使用标准Cochrane和ROBINS-I工具对偏差风险的评估.
主要成果:
- 包括16项研究 (2573名患者),主要使用德克斯梅德托米丁或黑激素激动剂.
- 超过一半的研究 (11/16) 报告了至少一个睡眠终点的显著改善.
- 偏差风险在RCT中较低,但在队列研究中中度至严重.
结论:
- 德克斯梅德托米丁和黑激素激动剂是对ICU睡眠最受研究的药理学药物.
- 目前的证据不支持这些药物的常规使用,以改善重症患者的睡眠.
- 未来的研究应该整合非药理学协议,并评估对睡眠生理学和患者结果的更广泛影响.
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