Bertolini G, Melotti R, Romano P, Cattaneo A, Mura G, Ruggiata R, Ravizza A, Brazzi L, Iapichino G
Istituto di Ricerche Farmacologiche Mario Negri, Centro di Ricerche Cliniche per le Malattie Rare Aldo e Cele Daccò, Ranica (Bergamo).
Minerva Anestesiol. 2001 Mar;67(3):97-105.
To assess the current practice of pharmacological sedation and analgesia in patients admitted in Italian intensive care units.
observational, prospective, cohort study, involving all patients admitted during a one-month period to participating Centers in 1994. All patients were followed-up for vital status until discharge and evaluated for pharmacological sedation and analgesia for the first week of ICU stay.
128 Italian, adult, general, intensive care units, approximately representing 1/3 of all Italian Units.
2932 patients were analyzed. They generated 22612 patient-days of intensive care unit stay, 11221 of which were evaluated.
A total of 31 different sedative drugs were used in 1751 patients. On 64% of sedated days only one drug was utilized, whereas two or more drugs were administered in the remaining days. Propofol was the most widely prescribed drug, followed by fentanyl and diazepam, while morphine accounted for 14.8% of sedated days. The analysis of the pattern of sedation over time revealed a trend to linearly reduce the use of this practice.
Our results depict a relatively low prevalence of sedation in Italy, with the use of large number of different agents. We also observed a larger than expected use of some drugs, like propofol and fentanyl, that could be due to the unavailability of new sedative and analgesic drugs in Italy on 1994. In conclusion, Italian intensivists seem to be very conservative about the practice of pharmacological sedation in critically ill patients.
评估意大利重症监护病房收治患者的药物镇静和镇痛现状。
观察性、前瞻性队列研究，纳入1994年参与研究中心1个月内收治的所有患者。对所有患者随访至出院时的生命状态，并对入住重症监护病房第一周的药物镇静和镇痛情况进行评估。
128家意大利成人综合性重症监护病房，约占意大利所有重症监护病房的三分之一。
分析了2932例患者。他们的重症监护病房住院天数共计22612天，其中11221天接受了评估。
1751例患者共使用了31种不同的镇静药物。在64%的镇静日仅使用了一种药物，其余日子则使用了两种或更多药物。丙泊酚是处方最多的药物，其次是芬太尼和地西泮，而吗啡占镇静日的14.8%。对镇静模式随时间变化的分析显示，这种做法的使用呈线性减少趋势。
我们的结果表明，意大利的镇静使用率相对较低，且使用了大量不同药物。我们还观察到一些药物的使用量高于预期，如丙泊酚和芬太尼，这可能是由于1994年意大利无法获得新的镇静和镇痛药物。总之，意大利重症监护医生在危重病患者药物镇静的做法上似乎非常保守。
