Department of Anesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Odense C, Denmark.
Minerva Anestesiol. 2011 Jan;77(1):59-63. Epub 2010 Nov 24.
With the first generation of ventilators, it was often necessary to sedate patients to avoid dyssynchrony between patient and ventilator. The standard treatment of patients in need of mechanical ventilation has therefore traditionally included sedation. Modern ventilators are able to simulate the patients breathing efforts to a higher degree, and therefore, deep sedation is no longer necessary. In the last decade, support has grown for a reduction in the use of sedation. The focus has been placed on the correlation between the depth of sedation and the length of mechanical ventilation. It has been shown that a daily wake up trial reduced the time that patients were dependent on mechanical ventilation. Additionally, it has been shown that combining both a spontaneous breathing trial and a daily wake up trial reduced the mechanical ventilation time compared to a spontaneous breathing trial alone. We have recently shown in a randomized study that the use of no sedation, compared to the standard treatment with sedation and a daily wake up trial, reduced the time that patients required mechanical ventilation, the length of the patients' stay in the intensive care unit, and the total length of the hospital stay. All evidence indicates that the use of sedative drugs should be reduced, patients should be mobilized, and each patient's needs should be evaluated on a daily basis to optimize the care of each individual patient.
第一代呼吸机常常需要对患者进行镇静，以避免人机不同步。因此，传统上，需要机械通气的患者的标准治疗包括镇静。现代呼吸机能够在更高程度上模拟患者的呼吸努力，因此不再需要深度镇静。在过去十年中，人们越来越支持减少镇静的使用。重点一直放在镇静深度与机械通气时间之间的相关性上。已经表明，每日唤醒试验可减少患者依赖机械通气的时间。此外，与单独进行自主呼吸试验相比，联合进行自主呼吸试验和每日唤醒试验可减少机械通气时间。我们最近在一项随机研究中表明，与使用镇静和每日唤醒试验的标准治疗相比，不使用镇静可减少患者需要机械通气的时间、患者在重症监护病房的停留时间和总住院时间。所有证据表明，应减少镇静药物的使用，应使患者活动，并应根据患者的需求进行每日评估，以优化每位患者的护理。
