University of North Carolina Eshelman School of Pharmacy, Division of Practice Advancement and Clinical Education, Chapel Hill, NC, United States.
University of Kentucky HealthCare, Department of Pharmacy Services, 800 Rose Street, Room H110, Lexington, KY 40536, United States; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, Lexington, KY, United States.
J Crit Care. 2018 Feb;43:102-107. doi: 10.1016/j.jcrc.2017.07.046. Epub 2017 Jul 29.
This single-center, retrospective cohort study investigated the effects of timing of initiating home neuropsychiatric medications (NPMs) on sedation-related outcomes.
Subjects included adult medical intensive care unit (MICU) patients who had an NPM on their admission medication list; intubated before or on arrival to the intensive care unit (ICU); and were on benzodiazepine-based sedation. The intervention assessed was the timing of the initiation of home NPMs: early (≤5days) vs. late (>5days) into the ICU stay.
There were 56 and 53 patients in the early and late restart groups, respectively. Early cohort patients maintained a median daily RASS of -1.5, while late cohort patients had a median daily RASS of -2.0 (p=0.02). The effect was driven by the subgroup of patients on home anti-depressant therapy who were restarted early on these agents. The early restart group had a higher percentage of days with RASS scores within goal (p=0.01) and less delirium (p=0.02). Early restarting of home NPMs was associated with a non-significant decrease in ventilator days compared with late restarting (p=0.11).
Restarting home NPMs was associated with lighter sedation levels and less delirium.
本单中心回顾性队列研究旨在探讨起始家庭神经精神药物（NPM）时间对镇静相关结局的影响。
研究对象包括成人重症监护病房（MICU）入院时药物清单上有 NPM、在入 ICU 前或入 ICU 时插管且接受苯二氮䓬类药物镇静的患者。评估的干预措施是家庭 NPM 起始时间：早期（≤5 天）与晚期（>5 天）。
早期和晚期重启组分别有 56 例和 53 例患者。早期队列患者的中位每日 RASS 为-1.5，而晚期队列患者的中位每日 RASS 为-2.0（p=0.02）。这种影响是由在家接受抗抑郁治疗并早期重新开始这些药物的患者亚组驱动的。早期重启组有更多天数的 RASS 评分达到目标（p=0.01），谵妄发生率更低（p=0.02）。与晚期重启相比，早期重启家庭 NPM 与呼吸机使用天数减少无显著相关性（p=0.11）。
重启家庭 NPM 与较低的镇静水平和更少的谵妄相关。
