Funk G-C
I. Interne Lungenabteilung mit Intensivstation, Otto Wagner Spital, Sanatoriumstrasse 2, 1140, Wien, Österreich.
Med Klin Intensivmed Notfmed. 2016 Feb;111(1):29-36. doi: 10.1007/s00063-015-0136-6. Epub 2016 Jan 27.
Avoiding pain, agitation and delirium as well as avoiding unnecessary deep sedation is a powerful yet challenging strategy in critical care medicine. A number of interactions between cerebral function and respiratory function should be regarded in patients with respiratory failure and mechanical ventilation. A cooperative sedation strategy (i.e. patient is awake and free of pain and delirium) is feasible in many patients requiring invasive mechanical ventilation. Especially patients with mild acute respiratory distress syndrome (ARDS) seem to benefit from preserved spontaneous breathing. While completely disabling spontaneous ventilation with or without neuromuscular blockade is not a standard strategy in ARDS, it might be temporarily required in patients with severe ARDS, who have substantial dyssynchrony or persistent hypoxaemia. Since pain, agitation and delirium compromise respiratory function they should also be regarded during noninvasive ventilation and during ventilator weaning. Pharmacological sedation can have favourable effects in these situations, but should not be given routinely or uncritically.
在危重症医学中，避免疼痛、躁动和谵妄以及避免不必要的深度镇静是一项有力但具有挑战性的策略。对于呼吸衰竭和机械通气患者，应考虑脑功能与呼吸功能之间的多种相互作用。在许多需要有创机械通气的患者中，采用合作性镇静策略（即患者清醒且无疼痛和谵妄）是可行的。尤其是轻度急性呼吸窘迫综合征（ARDS）患者似乎受益于保留自主呼吸。虽然在ARDS中完全抑制自主通气（无论是否使用神经肌肉阻滞剂）并非标准策略，但对于有严重不同步或持续低氧血症的重度ARDS患者，可能需要暂时采用该策略。由于疼痛、躁动和谵妄会损害呼吸功能，因此在无创通气和撤机过程中也应予以关注。在这些情况下，药物镇静可能会产生有利影响，但不应常规或不加区分地使用。
