From the *Intensive Care Unit, St Vincent's Hospital, Darlinghurst, Sydney, Australia; †Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia; and ‡Extracorporeal Life Support Organization, University of Michigan, Ann Arbor, MI.
ASAIO J. 2013 Nov-Dec;59(6):636-41. doi: 10.1097/MAT.0b013e3182a84558.
Sedation practice in extracorporeal membrane oxygenation (ECMO) is challenging, and some studies suggest that pharmacokinetics of sedative drugs are altered by the circuitry components. We conducted an international survey of sedation practice in centers offering veno-venous ECMO for adult patients in collaboration with the Extracorporeal Life Support Organization. A total 102 respondents participated representing various experienced centers from around the world. Fifty-eight percent responded that patients on ECMO have a higher or much higher sedation requirement than other critically ill patients, whilst 51% achieved a responsive or cooperative level of sedation. Midazolam (79%), morphine (43%) and fentanyl (45%) were most frequently used. Alpha-2 agonists were prescribed in 66% while propofol was used infrequently (36%). Thirty-five percent did not use continuous muscle relaxants. Responses from experienced users differed to those who reported less experience. Sedation practice in ECMO varies widely. Cooperative or responsive levels of sedation can frequently be achieved, and the drugs used differ from those used in non-ECMO patients.
体外膜肺氧合（ECMO）中的镇静实践具有挑战性，一些研究表明镇静药物的药代动力学会受到电路组件的影响。我们与体外生命支持组织合作，对为成人患者提供静脉-静脉 ECMO 的中心的镇静实践进行了国际调查。共有 102 名受访者参与，代表来自世界各地的各种经验丰富的中心。58%的受访者表示，ECMO 上的患者比其他危重症患者需要更高或更高的镇静要求，而 51%的患者达到了反应性或合作性的镇静水平。咪达唑仑（79%）、吗啡（43%）和芬太尼（45%）是最常使用的药物。66%的患者使用α-2 激动剂，而丙泊酚的使用频率较低（36%）。35%的患者不使用持续肌肉松弛剂。有经验的使用者的回答与报告经验较少的使用者的回答不同。ECMO 中的镇静实践差异很大。通常可以达到合作或反应性的镇静水平，并且使用的药物与非 ECMO 患者使用的药物不同。
