Harper University Hospital, Detroit, MI 48201, USA.
Am J Health Syst Pharm. 2010 Jun 15;67(12):1002-6. doi: 10.2146/ajhp090134.
The evidence evaluating daily interruption of sedation (DIS) in mechanically ventilated patients, the benefits of this intervention, and the barriers to its incorporation into clinical practice are reviewed.
Recent epidemiologic studies have identified a high prevalence of oversedation in the intensive care unit (ICU). The practice of DIS, which involves withholding all sedative and analgesic medications until patients are awake on a daily basis, can limit excessive sedation. DIS has been shown to reduce the duration of mechanical ventilation and length of ICU stay, lessen the number of neurodiagnostic tests to assess for changes in mental status, decrease the frequency of complications associated with critical illness, and reduce the total dose of benzodiazepines and opiates administered. Although recent studies support the use of DIS, it remains underutilized in clinical practice and additional trials may be needed before this intervention will gain widespread acceptance. Barriers to the use of DIS include a lack of nursing acceptance and concerns regarding patient removal of invasive devices, patient discomfort, respiratory compromise, and withdrawal syndromes. Some clinicians are also concerned about the possibility of long-term psychological sequelae and the risk of myocardial ischemia during DIS in patients with coronary risk factors.
DIS limits oversedation in the ICU without compromising patient comfort or safety and should be incorporated into the routine care of mechanically ventilated patients. Clinicians should be aware of the numerous barriers that prevent the use of DIS and address these at their institution to increase its use.
本文回顾了评估机械通气患者每日镇静中断（DIS）的证据、该干预措施的益处，以及其纳入临床实践的障碍。
最近的流行病学研究表明，重症监护病房（ICU）中存在过度镇静的高患病率。每日中断镇静（DIS）的做法包括每天停止给予所有镇静和镇痛药物，直到患者清醒，这可以限制过度镇静。DIS 已被证明可以缩短机械通气时间和 ICU 住院时间，减少评估精神状态变化的神经诊断测试次数，降低与危重病相关的并发症发生率，并减少给予的苯二氮䓬类和阿片类药物的总剂量。尽管最近的研究支持使用 DIS，但它在临床实践中的应用仍然不足，可能需要更多的试验，才能使这种干预措施得到广泛接受。DIS 的使用障碍包括护理人员接受度低，以及对患者移除侵入性设备、患者不适、呼吸受损和戒断综合征的担忧。一些临床医生还担心 DIS 可能导致长期心理后遗症，以及在有冠状动脉风险因素的患者中 DIS 期间发生心肌缺血的风险。
DIS 可限制 ICU 中的过度镇静，而不会影响患者的舒适度或安全性，应将其纳入机械通气患者的常规治疗中。临床医生应了解阻止 DIS 使用的诸多障碍，并在其所在机构解决这些障碍，以增加其使用。
