Shinotsuka Cassia Righy, Salluh Jorge Ibrain Figueira
Instituto D’Or de Pesquisa e Ensino - IDOR - Rio de Janeiro RJ, Brazil.
Rev Bras Ter Intensiva. 2013 Apr-Jun;25(2):155-61. doi: 10.5935/0103-507X.20130027.
A significant number of landmark studies have been published in the last decade that increase the current knowledge on sedation for critically ill patients. Therefore, many practices that were considered standard of care are now outdated. Oversedation has been shown to be hazardous, and light sedation and no-sedation protocols are associated with better patient outcomes. Delirium is increasingly recognized as a major form of acute brain dysfunction that is associated with higher mortality, longer duration of mechanical ventilation and longer lengths of stay in the intensive care unit and hospital. Despite all the available evidence, translating research into bedside care is a daunting task. International surveys have shown that practices such as sedation interruption and titration are performed only in the minority of cases. Implementing best practices is a major challenge that must also be addressed in the new guidelines. In this review, we summarize the findings of sedation and delirium research over the last years. We also discuss the gap between evidence and clinical practice and highlight ways to implement best practices at the bedside.
在过去十年中，已经发表了大量具有里程碑意义的研究，这些研究增加了我们目前对危重症患者镇静的认识。因此，许多曾被视为标准治疗方法的做法现在已经过时。过度镇静已被证明是有害的，轻度镇静和无镇静方案与更好的患者预后相关。谵妄越来越被认为是急性脑功能障碍的一种主要形式，它与更高的死亡率、更长的机械通气时间以及在重症监护病房和医院的更长住院时间相关。尽管有所有这些现有证据，但将研究成果转化为床边护理是一项艰巨的任务。国际调查显示，诸如镇静中断和滴定等做法仅在少数情况下实施。实施最佳实践是一项重大挑战，新指南中也必须加以解决。在本综述中，我们总结了过去几年镇静和谵妄研究的结果。我们还讨论了证据与临床实践之间的差距，并强调了在床边实施最佳实践的方法。
