北欧和非北欧 ICU 镇静实践：一项欧洲调查。
Sedation practice in Nordic and non-Nordic ICUs: a European survey.
机构信息
University of Copenhagen, and Trauma Centre, Rigshospitalet, Copenhagen DK-2100, Denmark.
出版信息
Nurs Crit Care. 2013 Jul;18(4):166-75. doi: 10.1111/nicc.12003. Epub 2013 Jan 25.
BACKGROUND AND AIMS
A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries.
DESIGN AND METHODS
A cross-sectional survey of ICU nurses attending the fourth European federation of Critical Care Nursing associations (EfCCNa) in Denmark, 2011. Data included use of protocols; sedation, pain and delirium assessment tools; collaborative decision-making; sedation and analgesic medications; and educational preparation related to sedation.
RESULTS
Response rate was 42% (n = 291) from 22 countries where 53% (n = 148) used sedation protocols. Nordic nurses reported greater use of sedation (91% versus 67%, p < 0·01) and pain (91% versus 69%, p < 0·01) assessment tools than non-Nordic nurses. Decision-making on sedation was more inter-professionally collaborative in Nordic ICUs (83% versus 61%, p < 0·01), units were smaller (10 versus 15 beds, p < 0·01) and nurse-patient ratio was higher (1:1, 75% versus 26%, p < 0·01). Nordic nurses reported greater consistency in maintaining circadian rhythm (66% versus 49%, p < 0·01), less use of physical restraints (14% versus 36%, p < 0·01), less use of neuromuscular blocking agents (3% versus 16%, p < 0·01), and received more sedation education (92% versus 76%, p < 0·01). Delirium assessment was not performed systematically in most settings.
CONCLUSIONS
Organizational and contextual factors, such as ICU size, staffing ratio and inter-professional collaboration, are contributing factors to sedation management in European ICUs. The Nordic context might be more germane to the goal of lighter sedation and better pain management.
RELEVANCE TO CLINICAL PRACTICE
Our study raises awareness of current sedation practice, paving the way towards optimized ICU sedation management.
背景与目的
在许多重症监护病房（ICU）中，镇静治疗的趋势越来越轻。本调查的目的是描述欧洲 ICU 中的镇静实践，并比较北欧和非北欧国家的镇静实践。
方法
这是 2011 年在丹麦举行的第四次欧洲危重病护理协会联合会（EfCCNa）会议上对 ICU 护士进行的一项横断面调查。数据包括使用方案；镇静、疼痛和谵妄评估工具；协作决策；镇静和镇痛药物；以及与镇静相关的教育准备。
结果
来自 22 个国家的 291 名护士做出了回应，其中 53%（n=148）使用镇静方案。北欧护士报告说，他们比非北欧护士更常使用镇静（91%对 67%，p<0.01）和疼痛（91%对 69%，p<0.01）评估工具。在北欧 ICU 中，镇静决策更具专业性（83%对 61%，p<0.01），病房更小（10 张床对 15 张床，p<0.01），护士与患者的比例更高（1:1，75%对 26%，p<0.01）。北欧护士报告说，他们在维持昼夜节律方面更具一致性（66%对 49%，p<0.01），较少使用身体约束（14%对 36%，p<0.01），较少使用神经肌肉阻滞剂（3%对 16%，p<0.01），并接受了更多的镇静教育（92%对 76%，p<0.01）。在大多数情况下，没有系统地进行谵妄评估。
结论
组织和背景因素，如 ICU 规模、人员配备比例和跨专业合作，是欧洲 ICU 镇静管理的促成因素。北欧的情况可能更符合轻度镇静和更好的疼痛管理的目标。
临床意义
我们的研究提高了对当前镇静实践的认识，为优化 ICU 镇静管理铺平了道路。
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