Weinert Craig R, Calvin Andrew D
Division of Pulmonary, Allergy, and Critical Care Medicine and the Clinical Outcomes Research Center, University of Minnesota Medical School, Minneapolis, MN, USA.
Crit Care Med. 2007 Feb;35(2):393-401. doi: 10.1097/01.CCM.0000254339.18639.1D.
Describe the pharmacoepidemiology of sedative medications and nurse-rated patients' behavior and sedation adequacy.
Cohort study, 2001-2003.
Patients ventilated for >36 hrs in a medical or surgical intensive care unit at a university-affiliated hospital. Proxies for 312 eligible subjects were approached for consent, 277 subjects enrolled, and data from 274 subjects were analyzed.
None.
Distribution of Arousal and Motor Activity levels, proportion of inadequate sedation and factors associated with inadequate sedation, variation of sedative therapy intensity, and behavior over time were measured. Sedatives were administered in 85% of 18,050 four-hour intervals during mechanical ventilation. Sedation was judged as adequate in 83% of 12,414 sedation assessments; patients were judged to be undersedated in 13.9% and oversedated in 2.6% of the assessments. Patients were unarousable or minimally arousable 32% of the time and had no spontaneous motor activity (during a 10-min observation period) 21.5% of the time. There was little variation in level of consciousness or motor activity or drug dose over 24 hrs, but daytime caregivers were more likely to judge patients as oversedated (3.7%) compared with nighttime caregivers (1.6%, p<.001). Inadequate sedation was associated with sedative drug intensity and patient behavior as measured by a two-domain sedation scale. Sedative drug intensity and behavior varied during the course of respiratory failure, and survivors received 13% more sedation per 4-hr interval of mechanical ventilation than nonsurvivors (p<.001).
Although patients were minimally arousable or nonarousable in 32% and motionless in 21% of the sedation assessments, surprisingly, an oversedation rating occurred in <3%. This discrepancy, along with findings that time of day influences the interpretation of sedation adequacy and that patients' behavior change over time suggests that collaborative research is needed to define adequate sedation.
描述镇静药物的药物流行病学以及护士评定的患者行为和镇静充分性。
队列研究，2001 - 2003年。
在一所大学附属医院的内科或外科重症监护病房接受机械通气超过36小时的患者。向312名符合条件的受试者的代理人征求同意，277名受试者入组，并对274名受试者的数据进行分析。
无。
测量觉醒和运动活动水平的分布、镇静不足的比例及与镇静不足相关的因素、镇静治疗强度的变化以及随时间推移的行为。在机械通气期间，18050个四小时时间段中有85%使用了镇静剂。在12414次镇静评估中，83%的评估判定镇静充分；在13.9%的评估中患者被判定镇静不足，在2.6%的评估中被判定镇静过度。患者在32%的时间内无法唤醒或仅有轻微唤醒，在21.5%的时间内（在10分钟观察期内）无自主运动活动。在24小时内意识水平、运动活动或药物剂量几乎没有变化，但与夜间护理人员（1.6%，p<0.001）相比，白天护理人员更有可能将患者判定为镇静过度（3.7%）。根据两域镇静量表测量，镇静不足与镇静药物强度和患者行为相关。在呼吸衰竭过程中，镇静药物强度和行为有所变化，幸存者在机械通气的每4小时时间段内接受的镇静比非幸存者多13%（p<0.001）。
尽管在32%的镇静评估中患者仅有轻微唤醒或无法唤醒，在21%的评估中静止不动，但令人惊讶的是，镇静过度的评定发生率不到<%.这种差异，以及一天中的时间影响对镇静充分性的判断以及患者行为随时间变化的研究结果表明，需要开展合作研究来界定充分镇静。
