Lizza Bryan D, Jagow Benjamin, Hensler David, Cooper Craig J, Short Elizabeth J, Maas Matthew B, Naidech Andrew M, Wunderink Richard G
1 Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA.
2 Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Pharm Pract. 2018 Oct;31(5):445-449. doi: 10.1177/0897190017729522. Epub 2017 Sep 6.
Incorporation of a single daily assessment by a clinical pharmacist to improve adherence with a sedation protocol is associated with reduced duration of mechanical ventilation and intensive care unit (ICU) length of stay (LOS). We test the feasibility of incorporating a clinical pharmacist into more frequent sedation assessments and observed whether there are any potential differences in the sedatives administered.
Prospective, quasi-experimental, pilot study of patients admitted to the medical ICU. Patients were included in the analysis if ≥18 years of age within the first 24 hours of initiation of mechanical ventilation. Our primary intent was to test the clinical feasibility surrounding more frequent sedation assessments by a clinical pharmacist by evaluating potential differences in time in target sedation range and sedative administration. Exploratory efficacy end points included time in target sedation range (0 to -2) using the Richmond Agitation Sedation Scale (RASS) and sedative exposure. Patients were assigned to receive either 3 assessments with a clinical pharmacist per day (intervention) or a single assessment by a clinical pharmacist per day (standard of care). During the assessments, clinical pharmacists participated in the RASS administration and made dosing adjustments according to an established sedation protocol.
Seventeen patients were enrolled (n = 6 intervention group, n = 11 standard of care). Duration of mechanical ventilation was similar in the 2 groups (intervention 100.0 hours [52.5-197.5] vs control 76.0 hours [46.0-201.0], P = .95), but patients in the intervention group exhibited a greater percentage time in the target RASS range (intervention 76.0% [53.7-81.5%] vs control 45.2% [35.3-67.0], P = .11) that was not statistically significant. Patients in the intervention group received less fentanyl per day (820.9 µg [227.3-1579.4] vs 1997 µg [1648.2-2477.2], P = .02) than in the control group.
Incorporating a clinical pharmacist into more frequent daily sedation assessments was associated with a reduction in fentanyl administration. There were no observed differences in time in target sedation range or reduction in duration of mechanical ventilation.
临床药师每日进行一次评估以提高对镇静方案的依从性，这与机械通气时间缩短及重症监护病房（ICU）住院时间（LOS）缩短相关。我们测试将临床药师纳入更频繁的镇静评估的可行性，并观察所使用的镇静剂是否存在任何潜在差异。
对入住内科ICU的患者进行前瞻性、准实验性的试点研究。在机械通气开始后的头24小时内年龄≥18岁的患者纳入分析。我们的主要目的是通过评估目标镇静范围内的时间及镇静剂使用的潜在差异，测试临床药师进行更频繁镇静评估的临床可行性。探索性疗效终点包括使用里士满躁动镇静量表（RASS）评估的目标镇静范围内的时间（0至-2）及镇静剂暴露情况。患者被分配接受每天由临床药师进行3次评估（干预组）或每天由临床药师进行1次评估（护理标准组）。在评估期间，临床药师参与RASS评估，并根据既定的镇静方案进行剂量调整。
共纳入17例患者（干预组n = 6，护理标准组n = 11）。两组的机械通气时间相似（干预组100.0小时[52.5 - 197.5]，对照组76.0小时[46.0 - 201.0]，P = 0.95），但干预组患者在目标RASS范围内的时间百分比更高（干预组76.0%[53.7 - 81.5%]，对照组45.2%[35.3 - 67.0]，P = 0.11），差异无统计学意义。干预组患者每天接受的芬太尼剂量低于对照组（820.9μg[227.3 - 1579.4]，对照组1997μg[1648.2 - 2477.2]，P = 0.02）。
将临床药师纳入更频繁的每日镇静评估与芬太尼使用量减少相关。在目标镇静范围内的时间或机械通气时间缩短方面未观察到差异。
