Devlin John W
Northeastern University School of Pharmacy, Boston, Massachusetts 02115, USA.
Curr Opin Crit Care. 2008 Aug;14(4):403-7. doi: 10.1097/MCC.0b013e32830280b3.
To review pharmacological-related factors that affect the incidence of oversedation in mechanically ventilated adults.
Recent epidemiologic studies have identified a high frequency of oversedation in the ICU that is attributable, in part, to a number of pharmacokinetic, pharmacogenetic, and pharmacodynamic factors. New evidence suggests that the administration of benzodiazepines, even when dosed intermittently, will lead to more oversedation than either propofol or dexmedetomidine and is associated with greater healthcare costs. Based on this data, clinicians should limit the use of benzodiazepines to those patients with anxiety, seizures, alcohol withdrawal, or in whom a deeper level of sedation or therapeutic paralysis is required.
Recognition of these new advances will help liberate patients from mechanical ventilation sooner, without compromising patient comfort.
回顾影响机械通气成年患者过度镇静发生率的药物相关因素。
近期的流行病学研究已确定重症监护病房（ICU）中过度镇静的发生率较高，部分原因是一些药代动力学、药物遗传学和药效学因素。新证据表明，即使间歇给药，苯二氮䓬类药物的使用也会比丙泊酚或右美托咪定导致更多的过度镇静，且与更高的医疗成本相关。基于这些数据，临床医生应将苯二氮䓬类药物的使用限制于有焦虑、癫痫、酒精戒断症状的患者，或需要更深程度镇静或治疗性麻痹的患者。
认识到这些新进展将有助于患者更快地脱离机械通气，同时不影响患者舒适度。
