Carson Shannon S, Kress John P, Rodgers Jo Ellen, Vinayak Ajeet, Campbell-Bright Stacy, Levitt Joseph, Bourdet Sharya, Ivanova Anastasia, Henderson Ashley G, Pohlman Anne, Chang Lydia, Rich Preston B, Hall Jesse
Division of Pulmonary and Critical Care, Department of Medicine, University of North Carolina at Chapel Hill, 4134 Bioinformatics Building, Chapel Hill, NC 27599-7020, USA.
Crit Care Med. 2006 May;34(5):1326-32. doi: 10.1097/01.CCM.0000215513.63207.7F.
To compare duration of mechanical ventilation for patients randomized to receive lorazepam by intermittent bolus administration vs. continuous infusions of propofol using protocols that include scheduled daily interruption of sedation.
A randomized open-label trial enrolling patients from October 2001 to March 2004.
Medical intensive care units of two tertiary care medical centers.
Adult patients expected to require mechanical ventilation for >48 hrs and who required > or =10 mg of lorazepam or a continuous infusion of a sedative to achieve adequate sedation.
Patients were randomized to receive lorazepam by intermittent bolus administration or propofol by continuous infusion to maintain a Ramsay score of 2-3. Sedation was interrupted on a daily basis for both groups.
The primary outcome was median ventilator days. Secondary outcomes included 28-day ventilator-free survival, intensive care unit and hospital length of stay, and hospital mortality. Median ventilator days were significantly lower in the daily interruption propofol group compared with the intermittent bolus lorazepam group (5.8 vs. 8.4, p = .04). The difference was largest for hospital survivors (4.4 vs. 9.0, p = .006). There was a trend toward greater ventilator-free survival for patients in the daily interruption propofol group (median 18.5 days for propofol vs. 10.2 for lorazepam, p = .06). Hospital mortality was not different.
For medical patients requiring >48 hrs of mechanical ventilation, sedation with propofol results in significantly fewer ventilator days compared with intermittent lorazepam when sedatives are interrupted daily.
比较随机接受间断推注劳拉西泮与持续输注丙泊酚的患者机械通气时间，使用包括每日定时中断镇静的方案。
一项随机开放标签试验，于2001年10月至2004年3月招募患者。
两家三级医疗中心的医学重症监护病房。
预计需要机械通气超过48小时且需要10毫克或更多劳拉西泮或持续输注镇静剂以达到充分镇静的成年患者。
患者随机接受间断推注劳拉西泮或持续输注丙泊酚以维持Ramsay评分2 - 3。两组均每日中断镇静。
主要结局是机械通气天数中位数。次要结局包括28天无呼吸机生存、重症监护病房和住院时间以及医院死亡率。与间断推注劳拉西泮组相比，每日中断丙泊酚组的机械通气天数中位数显著更低（5.8天对8.4天，p = 0.04）。对于医院幸存者，差异最大（4.4天对9.0天，p = 0.006）。每日中断丙泊酚组患者无呼吸机生存有增加趋势（丙泊酚组中位数18.5天对劳拉西泮组10.2天，p = 0.06）。医院死亡率无差异。
对于需要机械通气超过48小时的内科患者，当每日中断镇静剂时，丙泊酚镇静导致的机械通气天数显著少于间断使用劳拉西泮。
