Feeley Kathy, Gardner Anne
Intensive Care Unit, The Canberra Hospital, Canberra, ACT.
Aust Crit Care. 2006 May;19(2):73-7. doi: 10.1016/s1036-7314(06)80012-3.
The quality of sedation management in mechanically ventilated patients has been a source of concern in recent years. This paper summarises the literature on the principles of optimal sedation, discusses the consequences of over and undersedation, highlighting the importance of appropriate pain management, and presents a case study using the results of an audit of 48 mechanically ventilated adults. As a result of the review and audit, we are implementing changes to practice. The most important recommendations from the literature are the use of a sedation scale, setting of a goal sedation score, appropriate pain management and implementation of a nurse initiated sedation algorithm. Other recommendations include use of bolus rather than continuous sedative infusions and recommencing regular medications for anxiety, depression and other phychiatric disorders as soon as possible. A recommendation arising from our audit was the need to identify patients at high risk of oversedation and undersedation and adopt a proactive rather than reactive approach to management. The practice goal is to provide adequate and appropriate analgesia and anxiolysis for patients. This will improve patient comfort while reducing length of mechanical ventilation and minimising risk of complications.
近年来，机械通气患者的镇静管理质量一直备受关注。本文总结了关于最佳镇静原则的文献，讨论了镇静过度和不足的后果，强调了适当疼痛管理的重要性，并通过对48例机械通气成年患者的审计结果进行了案例研究。通过此次综述和审计，我们正在对实践进行改进。文献中最重要的建议包括使用镇静评分量表、设定目标镇静评分、适当的疼痛管理以及实施由护士启动的镇静算法。其他建议包括使用推注而非持续输注镇静剂，并尽快重新开始使用治疗焦虑、抑郁和其他精神疾病的常规药物。我们的审计得出的一项建议是，需要识别出镇静过度和不足风险高的患者，并采取积极主动而非被动反应的管理方法。实践目标是为患者提供充分且适当的镇痛和抗焦虑治疗。这将提高患者的舒适度，同时缩短机械通气时间并将并发症风险降至最低。
