护士在重症监护病房对成人进行机械通气撤机过程中的镇静实践。

Nurses' Sedation Practices During Weaning of Adults From Mechanical Ventilation in an Intensive Care Unit.

机构信息

Marta Borkowska is a registered nurse in the surgical intensive care unit at Ghent University Hospital, Ghent, Belgium. Sonia Labeau is head of the nursing degree program, Faculty of Education, Health, and Social Work, University College Ghent, Ghent, Belgium. Tom Schepens is a clinical fellow, Department of Critical Care Medicine, Hospital for Sick Children, University of Toronto, Canada, and a doctoral student at University of Antwerp, Antwerp, Belgium. Dominique Vandijck is a professor, Faculty of Medicine and Life Sciences, Department of Patient Safety, Hasselt University, Diepenbeek, Belgium, and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium, and director of quality and safety, Zorgnet-Icuro, Brussels, Belgium. Katrien Van de Vyver is an infection prevention and control nurse, AZ Maria Middelares Hospital, Ghent, Belgium. Daphné Christiaens is a study nurse, SAFE-PEDRUG study team, Pediatric Nephrology and Rheumatology, Ghent University Hospital. Christelle Lizy is head nurse, Nephrology, Endocrinology, Cardiology Department, Ghent University Hospital. Bronagh Blackwood is professor of critical care, Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland. Stijn I. Blot is a research professor, Department of Internal Medicine, Ghent University, and an honorary professor, Burns Trauma and Critical Care Research Centre, University of Queensland, Bris-bane, Australia.

出版信息

Am J Crit Care. 2018 Jan;27(1):32-42. doi: 10.4037/ajcc2018959.

DOI:10.4037/ajcc2018959

PMID:29292273

Abstract

BACKGROUND

Sedation and analgesia have an important impact on the outcome of patients treated with mechanical ventilation. International guidelines recommend use of sedation protocols to ensure best patient care.

OBJECTIVE

To determine the sedation practice of intensive care nurses weaning adults from mechanical ventilation.

METHODS

A cross-sectional survey with a self-administered questionnaire was used to determine sedation practices of Flemish critical care nurses during weaning. Consensus on content validity was achieved through a Delphi procedure among experts. Data were collected during the 32nd Annual Congress of the Flemish Society of Critical Care Nurses in Ghent, Belgium, December 2014.

RESULTS

A total of 342 nurses were included in the study. Of these, 43.7% had a sedation protocol in their unit that was used by 61.8% of the respondents. Sedation protocols were more often available ( < .001) in academic hospitals (72%) than in general hospitals (41.5%). Sedatives were administered via continuous infusion with bolus doses if needed (81%). Level of sedation was assessed every 2 hours (56%), mostly via the Richmond Agitation-Sedation Scale (59.1%). Daily interruption of sedation was used by 16.5% of respondents. The biggest barriers to daily interruption were patient comfort (49.4%) and fear of respiratory worsening (46.6%).

CONCLUSIONS

A considerable discrepancy exists between international recommendations and actual sedation practices. Standardization of sedation practices across different institutions on a regional and national level may improve the quality of care.

摘要

背景

镇静和镇痛对接受机械通气治疗的患者的转归有重要影响。国际指南建议使用镇静方案，以确保为患者提供最佳的护理。

目的

确定为成人进行机械通气撤机的重症监护护士的镇静实践。

方法

采用横断面调查和自我管理问卷，确定 Flemish 重症监护护士在撤机期间的镇静实践。通过专家德尔菲法达成内容效度共识。数据于 2014 年 12 月在比利时根特举行的 Flemish 重症监护护士学会第 32 届年会上收集。

结果

共有 342 名护士参与了这项研究。其中，43.7%的单位有镇静方案，61.8%的受访者使用。学术医院（72%）比综合医院（41.5%）更常提供镇静方案（<.001）。镇静剂通过持续输注，如果需要则给予推注（81%）。镇静程度每 2 小时评估一次（56%），主要通过 Richmond 躁动-镇静量表（59.1%）评估。16.5%的受访者使用每日镇静中断。每日镇静中断的最大障碍是患者舒适度（49.4%）和对呼吸恶化的担忧（46.6%）。