Arroliga Alejandro, Frutos-Vivar Fernando, Hall Jesse, Esteban Andres, Apezteguía Carlos, Soto Luis, Anzueto Antonio
Cleveland Clinic Foundation, Ohio, USA.
Chest. 2005 Aug;128(2):496-506. doi: 10.1378/chest.128.2.496.
To describe the use of sedatives and neuromuscular blocking agents (NMBs) and their impact in outcome in an international cohort of patients receiving mechanical ventilation.
We analyzed the database of a prospective, multicenter cohort of 5,183 adult patients who received mechanical ventilation for > 12 h. We considered that a patient received a given agent when it was administered for at least 3 h in a 24-h period.
A total of 3,540 patients (68%; 95% confidence interval [CI], 67 to 69%) received a sedative at any time while receiving mechanical ventilation. The median number of days of use was 3 (interquartile range [IQR], 2 to 6 days). The persistent use of sedative was associated with more days of mechanical ventilation (median, 4 days [IQR, 2 to 8 days], vs 3 days [IQR, 2 to 4 days] in patients who did not receive sedatives [p < 0.001]); more weaning days (median, 2 days [IQR, 1 to 3 days], vs 2 days [IQR, 1 to 5 days] in patients who did not receive sedatives [p < 0.001]); and longer length of stay in the ICU (median, 8 days [IQR, 5 to 15 days], vs 5 days [IQR, 3 to 9 days] in patients who did not receive sedatives [p < 0.001]). Six hundred eighty-six patients (13%; 95% CI, 12 to 14%) received an NMB for at least 1 day. The median number of days of use was 2 (IQR, 1 to 4 days). The administration of an NMB was independently related with age, a normal previous functional status, main reason of mechanical ventilation (patients with ARDS received more NMBs), and with patient management (patients requiring permissive hypercapnia, prone position, high level of positive end-expiratory pressure, and high airways pressure).
The use of sedatives is very common, and their use is associated with a longer duration of mechanical ventilation, weaning time, and stay in the ICU. NMBs are used in 13% of the patients and are associated with longer duration of mechanical ventilation, weaning time, stay in the ICU, and higher mortality.
描述镇静剂和神经肌肉阻滞剂（NMBs）的使用情况及其对接受机械通气的国际患者队列预后的影响。
我们分析了一个前瞻性、多中心队列的数据库，该队列包含5183例接受机械通气超过12小时的成年患者。当患者在24小时内接受某种药物治疗至少3小时时，我们认为该患者使用了该药物。
共有3540例患者（68%；95%置信区间[CI]，67%至69%）在接受机械通气期间的任何时间接受了镇静剂治疗。使用天数的中位数为3天（四分位间距[IQR]，2至6天）。持续使用镇静剂与机械通气天数增加相关（中位数，4天[IQR，2至8天]，未接受镇静剂的患者为3天[IQR，2至4天][p<0.001]）；撤机天数增加（中位数，2天[IQR，1至3天]，未接受镇静剂的患者为2天[IQR，1至5天][p<0.001]）；以及在重症监护病房（ICU）的住院时间延长（中位数，8天[IQR，5至15天]，未接受镇静剂的患者为5天[IQR，3至9天][p<0.001]）。686例患者（13%；95%CI，12%至14%）接受NMB治疗至少1天。使用天数的中位数为2天（IQR，1至4天）。NMB的使用与年龄、既往功能状态正常、机械通气的主要原因（急性呼吸窘迫综合征[ARDS]患者接受更多NMBs）以及患者管理（需要允许性高碳酸血症、俯卧位、高水平呼气末正压和高气道压力的患者）独立相关。
镇静剂的使用非常普遍，其使用与机械通气时间延长、撤机时间和在ICU的住院时间相关。13%的患者使用了NMBs，且与机械通气时间延长、撤机时间、在ICU的住院时间以及更高的死亡率相关。
