Department of Medicine, Yale University School of Medicine, New Haven, CT 06511, USA.
Am J Crit Care. 2013 Sep;22(5):e62-9. doi: 10.4037/ajcc2013835.
Anecdotal observation suggests that older patients in medical intensive care units receive higher doses of psychoactive medications during evening shifts than day and night shifts.
To determine the dosing patterns and total doses of fentanyl, lorazepam, and haloperidol according to nursing shift in a cohort of older patients in a medical intensive care unit.
The sample consisted of 309 patients 60 years and older admitted to the medical intensive care unit at Yale-New Haven Hospital, New Haven, Connecticut. Data on time, dosage, and route of administration of the drugs were collected. Data were analyzed by using a Bayesian random effects Poisson model adjusted for individual heterogeneity, excess zero doses, and important clinical covariates.
Mean age of the patients was 75 years; 58% received fentanyl, 55% received lorazepam, and 32% received haloperidol. Although dosing with fentanyl did not differ according to shift, doses of both lorazepam and haloperidol were higher during the evening shifts (4 pm to midnight) than during the day or night shifts. Compared with women, men received higher doses of both haloperidol and lorazepam and variability between shifts was greater.
In this longitudinal, observational sample of older patients, data indicated a positive association between dose levels of lorazepam and haloperidol during the evening nursing shifts relative to other shifts. Further investigation is needed to determine potential causes and to evaluate the impact on outcomes of sleep deprivation and delirium.
据观察，在医疗重症监护病房，老年患者在夜间轮班时接受的镇静药物和抗精神病药物剂量比白天和夜间轮班时更高。
旨在确定在耶鲁-纽黑文医院医疗重症监护病房的老年患者队列中，根据护理班次确定芬太尼、劳拉西泮和氟哌啶醇的给药模式和总剂量。
该样本包括康涅狄格州纽黑文市耶鲁-纽黑文医院医疗重症监护病房收治的 309 名 60 岁及以上的患者。收集了关于药物的时间、剂量和给药途径的数据。使用贝叶斯随机效应泊松模型对数据进行分析，该模型调整了个体异质性、过量零剂量和重要临床协变量。
患者的平均年龄为 75 岁；58%接受芬太尼，55%接受劳拉西泮，32%接受氟哌啶醇。虽然根据班次给药没有差异，但劳拉西泮和氟哌啶醇的剂量在夜间轮班（下午 4 点至午夜）比在白天或夜间轮班时更高。与女性相比，男性接受的氟哌啶醇和劳拉西泮剂量更高，班次之间的差异也更大。
在这项针对老年患者的纵向观察性研究样本中，数据表明，与其他班次相比，夜间护理班次时劳拉西泮和氟哌啶醇的剂量水平呈正相关。需要进一步调查以确定潜在原因，并评估睡眠剥夺和谵妄对结果的影响。
