Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium.
J Crit Care. 2011 Apr;26(2):113-21. doi: 10.1016/j.jcrc.2010.11.003. Epub 2011 Jan 26.
Excessive sedation is associated with prolonged mechanical ventilation and longer intensive care unit (ICU) and hospital stays. We evaluated the feasibility of using minimal sedation in the ICU.
Prospective observational study in a university hospital 34-bed medico-surgical department of intensive care. All adult patients who stayed in the ICU for more than 12 hours over a 2-month period were included. Intensive care unit admission diagnoses, severity scores, use of sedatives and/or opiates, duration of mechanical ventilation, length of ICU stay, and 28-day mortality were recorded for each patient.
Of the 335 patients (median age, 61 years) admitted during the study period, 142 (42%) received some sedation, most commonly with midazolam and propofol. Sedative agents were administered predominantly for short periods of time (only 10% of patients received sedation for >24 hours). One hundred fifty-five patients (46%) received mechanical ventilation, generating 15,240 hours of mechanical ventilation, of these, only 2993 (20%) hours were accompanied by a continuous sedative infusion. Self-extubation occurred in 6 patients, but only 1 needed reintubation.
In a mixed medical-surgical ICU, minimal use of continuous sedation seems feasible without apparent adverse effects.
过度镇静与机械通气时间延长、重症监护病房（ICU）和住院时间延长有关。我们评估了在 ICU 中使用最小镇静的可行性。
在一家大学医院的 34 张病床的内科和外科重症监护病房进行前瞻性观察性研究。在为期 2 个月的时间内，所有在 ICU 中停留超过 12 小时的成年患者均被纳入研究。记录每位患者的 ICU 入院诊断、严重程度评分、镇静剂和/或阿片类药物的使用、机械通气时间、ICU 住院时间和 28 天死亡率。
在研究期间收治的 335 名患者（中位年龄为 61 岁）中，有 142 名（42%）接受了一定程度的镇静治疗，最常用的镇静剂是咪达唑仑和丙泊酚。镇静剂主要用于短时间内（只有 10%的患者接受镇静治疗超过 24 小时）。155 名患者（46%）接受了机械通气，共产生了 15240 小时的机械通气时间，其中只有 2993 小时（20%）伴随着持续镇静输注。有 6 名患者自行拔管，但只有 1 名患者需要重新插管。
在混合内科和外科 ICU 中，最小程度地持续使用镇静剂似乎是可行的，且没有明显的不良反应。
