Rhoney Denise H, Murry Kellie R
Wayne State University College of Pharmacy and Allied Health Professions Department of Pharmacy Practice, USA.
J Intensive Care Med. 2003 May-Jun;18(3):139-45. doi: 10.1177/0885066603251200.
The objectives of this study were to describe the sedative, neuromuscular blocking agents (NMBA) and reversal agents utilized in adult intensive care units across the United States and determine the adherence to American College of Critical Care Medicine and Society of Critical Care Medicine (SCCM) guidelines. In addition, the authors assessed the use of written protocols, criteria used for selecting these agents, and monitoring practices. Questionnaires were mailed to attending physician members of SCCM in the spring of 1998. A cover letter was enclosed that explained the purpose of the survey asking the respondent to forward the questionnaire to a colleague if unable to complete. Four-hundred fifty-seven questionnaires were returned representing 393 different institutions for a response rate of 50.4% (393/780). Respondents were physicians (91.2%) practicing in a community (49.7%) or university teaching hospital (38.3%). The sedative agents used most often were opioids and benzodiazepines for >72 hours, and NMBA utilized were vecuronium and pancuronium for >24 hours. The most often cited indications for sedatives were agitation, anxiety/fear, and facilitation of intubation and maintenance of mechanical ventilation for NMBA. Only 32.6% used written protocols for sedatives and 46.8% for NMBA. Decisions regarding agent selection were based on clinician preference and experience and agent duration of action. Seventy-eight percent monitored sedative use primarily with the Glasgow Coma Scale and the modified Ramsay score. Monitoring of NMBA was used more frequently (91.3%) with peripheral nerve stimulation. The most common reversal agents used were naloxone and flumazenil for adverse drug effects. While many of the respondents indicated they used morphine and lorazepam for long-term sedation, the majority utilized midazolam and propofol for >24 hours despite the recommendation of SCCM. Vecuronium was prescribed more routinely than pancuronium. The number of institutions utilizing protocols for any of these agents was low; instead, decisions were based on clinician preference.
本研究的目的是描述美国成人重症监护病房使用的镇静剂、神经肌肉阻滞剂（NMBA）和逆转剂，并确定对美国重症医学学会和危重病医学会（SCCM）指南的遵循情况。此外，作者评估了书面方案的使用、选择这些药物的标准以及监测方法。1998年春季，向SCCM的主治医师成员邮寄了调查问卷。随附的一封说明信解释了调查目的，要求受访者若无法完成问卷则将其转发给同事。共收回457份问卷，代表393个不同机构，回复率为50.4%（393/780）。受访者为在社区医院（49.7%）或大学教学医院（38.3%）执业的医生（91.2%）。使用最频繁的镇静剂是使用超过72小时的阿片类药物和苯二氮䓬类药物，使用超过24小时的NMBA是维库溴铵和泮库溴铵。镇静剂最常被提及的适应证是躁动、焦虑/恐惧，对于NMBA是便于插管和维持机械通气。只有32.6%的人使用镇静剂书面方案，46.8%的人使用NMBA书面方案。关于药物选择的决定基于临床医生的偏好和经验以及药物的作用持续时间。78%的人主要使用格拉斯哥昏迷量表和改良拉姆齐评分来监测镇静剂的使用情况。外周神经刺激用于监测NMBA的情况更为频繁（91.3%）。最常用的逆转剂是用于药物不良反应的纳洛酮和氟马西尼。虽然许多受访者表示他们使用吗啡和劳拉西泮进行长期镇静，但尽管有SCCM的推荐，大多数人使用咪达唑仑和丙泊酚超过24小时。维库溴铵的处方比泮库溴铵更常规。使用这些药物中任何一种的书面方案的机构数量都很少；相反，决定是基于临床医生的偏好。
