Belpomme V, Devaud M-L, Pariente D, Ricard-Hibon A, Mantz J
Service d'anesthésie-réanimation-Smur, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
Ann Fr Anesth Reanim. 2009 Apr;28(4):307-10. doi: 10.1016/j.annfar.2009.01.016. Epub 2009 Mar 18.
The primary goal of sedation in emergency prehospital care is to guarantee the security of the mechanically ventilated patients by optimising their adaptation to the respirator. If the French prehospital guidelines are well codified, their applicability in routine clinical practice seem to be rather empirical. The aim of this national survey was to evaluate the use of the clinical sedation scales by the prehospital physicians. This prospective and clinical practice survey was begun in January 2005. An anonymous questionnaire was sent to the physicians working in the 377 Mobile Intensive Care Unit of the 105 French Emergency Medical Service System. The total response rate from physicians was 28% (n=497). Only 29% of the physicians (n=145) declared to use a sedation scale for a mechanically ventilated patient. The Ramsay score was used in 97% of the cases (n=141).The principal reasons given by the physicians for not using the sedation scales were their ignorance in 57% of the cases (n=200) and the systematic choice of a deep sedation in 42% of the cases (n=147). For 18% of them (n=62), the use of sedation scores was considered too complicated. The final results show that the utilisation ratio of the sedation scores is very low in emergency prehospital medicine and suggest that an effort toward improving the use of sedation in prehospital emergency medicine is necessary.
在院前急救中,镇静的主要目标是通过优化机械通气患者对呼吸机的适应性来确保其安全。尽管法国的院前指南有详尽的编纂,但在常规临床实践中的适用性似乎相当缺乏实证依据。这项全国性调查的目的是评估院前急救医生对临床镇静量表的使用情况。这项前瞻性的临床实践调查于2005年1月开始。一份匿名问卷被发送给法国紧急医疗服务系统105个移动重症监护单元中工作的医生。医生的总回复率为28%(n = 497)。只有29%的医生(n = 145)宣称会对机械通气患者使用镇静量表。其中97%的情况(n = 141)使用了拉姆齐评分。医生不使用镇静量表的主要原因,57%的情况(n = 200)是他们对此并不了解,42%的情况(n = 147)是他们一贯选择深度镇静。对于其中18%的医生(n = 62)来说,使用镇静评分被认为过于复杂。最终结果表明,在院前急救医学中镇静评分的使用率非常低,这表明有必要努力提高院前急救医学中镇静的使用情况。