Mehta Sangeeta, Burry Lisa, Fischer Sandra, Martinez-Motta J Carlos, Hallett David, Bowman Dennis, Wong Cindy, Meade Maureen O, Stewart Thomas E, Cook Deborah J
InterDepartmental Division of Critical Care Medicine, Mount Sinai Hospital.
Crit Care Med. 2006 Feb;34(2):374-80. doi: 10.1097/01.ccm.0000196830.61965.f1.
To characterize the perceived utilization of sedative, analgesic, and neuromuscular blocking agents, the use of sedation scales, algorithms, and daily sedative interruption in mechanically ventilated adults, and to define clinical factors that influence these practices.
Cross-sectional mail survey.
Canadian critical care practitioners.
A total of 273 of 448 eligible physicians (60%) responded. Respondents were well distributed with regard to age, years of practice, specialist certification, size of intensive care unit and hospital, and location of practice. Twenty-nine percent responded that a protocol/care pathway/guideline for the use of sedatives or analgesics is currently in use in their intensive care unit. Daily interruption of continuous infusions of sedatives or analgesics is practiced by 40% of intensivists. A sedation scoring system is used by 49% of respondents. Of these, 67% use the Ramsay scale, 10% use the Sedation-Agitation Scale, 9% use the Glasgow Coma Scale, and 8% use the Motor Activity Assessment Scale. Only 3.7% of intensivists use a delirium scoring system in their intensive care units. Only 22% of respondents currently have a protocol for the use of neuromuscular blocking agents in their intensive care unit, and 84% of respondents use peripheral nerve stimulation for monitoring. In patients receiving neuromuscular blocking agents for >24 hrs, 63.7% of respondents discontinue the neuromuscular blocking agent daily. Intensivists working in university-affiliated hospitals are more likely to employ a sedation protocol and scale (p < .0001), as are intensivists working in larger intensive care units (>or=15 beds, p < .01). Intensivists with anesthesiology training (and no formal critical care training) are more likely to use a protocol and sedation scale, and critical care-trained intensivists are more likely to use daily interruption. Younger physicians (<40 yrs) are more likely to practice daily interruption (p = .0092).
There is significant variation in critical care sedation, analgesia, and neuromuscular blockade practice. Given the potential effect of practices regarding these medications on patient outcome, future research and educational efforts related to evidence-based protocols for the use of these agents in mechanically ventilated patients might be worthwhile.
描述机械通气成年患者中镇静剂、镇痛药和神经肌肉阻滞剂的使用情况、镇静评分量表、算法及每日镇静中断的应用情况，并确定影响这些操作的临床因素。
横断面邮寄调查。
加拿大重症监护从业者。
448名符合条件的医生中有273名（60%）回复。在年龄、从业年限、专科认证、重症监护病房和医院规模以及执业地点方面，回复者分布良好。29%的回复者称其所在重症监护病房目前使用镇静剂或镇痛药的方案/护理路径/指南。40%的重症监护医生实行每日中断持续输注镇静剂或镇痛药。49%的回复者使用镇静评分系统。其中，67%使用拉姆齐量表，10%使用镇静-躁动量表，9%使用格拉斯哥昏迷量表，8%使用运动活动评估量表。只有3.7%的重症监护医生在其重症监护病房使用谵妄评分系统。目前只有22%的回复者所在重症监护病房有神经肌肉阻滞剂的使用方案，84%的回复者使用外周神经刺激进行监测。在接受神经肌肉阻滞剂治疗超过24小时的患者中，63.7%的回复者每日停用神经肌肉阻滞剂。在大学附属医院工作的重症监护医生更有可能采用镇静方案和量表（p < .0001），在规模较大的重症监护病房（≥15张床位，p < .01）工作的医生也是如此。接受过麻醉学培训（无正式重症监护培训）的重症监护医生更有可能使用方案和镇静量表，接受过重症监护培训的重症监护医生更有可能进行每日中断。年轻医生（<40岁）更有可能进行每日中断（p = .0092）。
重症监护中的镇静、镇痛和神经肌肉阻滞操作存在显著差异。鉴于这些药物的使用操作对患者预后可能产生影响，未来针对机械通气患者使用这些药物的循证方案开展研究和教育工作可能是值得的。
