镇静的α2激动剂,以产生更好的临床结果 (A2B试验):一个随机对照试验的混合方法过程评估的协议
Leanne M Aitken1, Lydia M Emerson2, Kalliopi Kydonaki3
1School of Health & Psychological Sciences, City, University of London, London, UK.
BMJ open
|April 5, 2024
概括
本研究评估了在重症监护 (A2B试验) 中用于镇静的α-2激动剂,与常规护理相比,评估了它们的临床和成本效益. 过程评估探讨了影响复杂干预的因素.
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.
- 医疗服务研究 医疗服务研究
背景情况:
- 深度镇静与不良结果有关,但证据不一致.
- 像克洛尼丁和德克斯梅德托米丁这样的α-2激动剂是重症监护室 (ICU) 中镇静的潜在替代品.
- 在ICU中实施新的镇静方案是复杂的,因为实践和文化存在差异.
研究的目的:
- 在A2B镇静试验中,以确定α-2激动剂 (克罗尼丁,德克斯梅德托米丁) 与常规护理的临床和成本效益.
- 进行A2B干预的混合方法过程评估,以确定实施促进者和障碍.
- 探索干预交付和试验结果之间的关系.
主要方法:
- 由A2B干预逻辑模型指导的混合方法过程评估.
- 采用问卷,利益相关者访谈和例行收集的试验数据收集数据的两个阶段.
- 使用框架方法分析的定性数据,包括阶段内和跨阶段合成.
主要成果:
- 该A2B试验涉及39个英国ICU,突出了常规镇静和评估实践的显著差异.
- 预期的实施挑战包括常规实践的影响,风险感知,ICU文化和设备.
- 嵌入了过程评估,以了解影响交付和结果解释的因素.
结论:
- 了解实施因素对于A2B试验等复杂干预措施至关重要.
- 过程评估将提供关于阿尔法-2激动剂在重症监护镇静治疗中的成功输送的见解.
- 这项研究旨在改善集中护理机构的镇静实践和患者结果.
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