From the Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
ASAIO J. 2018 Jul/Aug;64(4):544-551. doi: 10.1097/MAT.0000000000000658.
Our objective was to characterize sedation management in adult patients with severe respiratory distress syndrome (ARDS) treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). We conducted a retrospective chart review of these patients treated at Toronto General Hospital between January 2012 and October 2015. Medications administered (sedative, analgesic, paralytic, and antipsychotic), sedation depth (Sedation Agitation Scale [SAS] score) delirium assessments, and mobilization were recorded daily. Forty-five adults (33 males, median age 47 years; interquartile range [IQR], 35-56]) with ARDS (median PaO2/FiO2 71; IQR 59-83) because of respiratory infection (91%) were treated with VV-ECMO for a median of 11 days (IQR, 7-17). After ECMO initiation, 96% patients were deeply sedated (SAS score < 3) with continuous infusions of midazolam (49%), propofol (18%), or both (29%) and 98% were receiving opioid infusions (93% fentanyl). Patients were deeply sedated for a median of 6 days (IQR, 3-10) after cannulation before transitioning to intermediate or light sedation (SAS score ≥ 3). Before ECMO discontinuation, 77% of surviving patients were intermediately or lightly sedated, 20% were receiving no sedatives, and 9% were receiving no opioids. During ECMO, 58% had positive delirium assessment and 24% experienced agitation (SAS ≥ 6). During ECMO support, 71% received physical therapy that occurred after a median of 7 days (IQR, 4-12) after cannulation. In conclusion, we found that although patients were deeply sedated for a prolonged duration after VV-ECMO initiation, many were able to safely achieve light sedation and active mobilization.
我们的目的是描述接受静脉-静脉体外膜肺氧合（VV-ECMO）治疗的成人严重呼吸窘迫综合征（ARDS）患者的镇静管理情况。我们对 2012 年 1 月至 2015 年 10 月期间在多伦多总医院接受治疗的这些患者进行了回顾性图表审查。记录了给予的药物（镇静药、镇痛药、肌松药和抗精神病药）、镇静深度（镇静躁动评分[SAS]评分）、谵妄评估和活动情况。共纳入 45 例成人（33 例男性，中位年龄 47 岁；四分位距[IQR]，35-56），因呼吸感染（91%）接受 VV-ECMO 治疗，中位 ARDS 持续时间为 11 天（IQR，7-17）。在 ECMO 开始后，96%的患者接受深度镇静（SAS 评分＜3），持续输注咪达唑仑（49%）、丙泊酚（18%）或两者（29%），98%的患者接受阿片类药物输注（93%芬太尼）。在插管后，中位镇静时间为 6 天（IQR，3-10），随后过渡到中度或轻度镇静（SAS 评分≥3）。在 ECMO 停止前，77%存活患者处于中度或轻度镇静状态，20%未接受镇静剂，9%未接受阿片类药物。在 ECMO 支持期间，58%的患者有阳性谵妄评估，24%的患者有躁动（SAS≥6）。在 ECMO 支持期间，71%的患者接受了物理治疗，中位数为插管后 7 天（IQR，4-12）。总之，我们发现尽管患者在 VV-ECMO 开始后长时间深度镇静，但许多患者能够安全地实现轻度镇静和积极活动。
