Department of Pharmacy, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, Columbus, OH 43210, USA.
Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, Columbus, OH 43210, USA.
J Crit Care. 2019 Apr;50:195-200. doi: 10.1016/j.jcrc.2018.11.029. Epub 2018 Nov 30.
Analgesia and sedation protocols (ASPs) reduce duration of mechanical ventilation (MV) in the medical intensive care unit (ICU), but data in the surgical ICU (SICU) are limited. The objective of this study was to determine the impact of a nursing-driven ASP with criteria for infusion initiation in the SICU.
A single-center, retrospective study compared ventilator-free days at day 28 from start of MV (VFD28) before and after ASP implementation. Secondary endpoints included cumulative opioid and sedative requirements, level of sedation, incidence of delirium, SICU and hospital length of stay.
One hundred thirty two patients were included (66 per group). The protocol group had greater VFD28 compared to the control group (21 vs. 14.5 days, p = .04). Lower rates of benzodiazepine (42.4% vs. 84.8%, p < .001) and opioid (24.2 vs. 78.8, p < .001) infusion use occurred in the protocol group, resulting in lower cumulative doses per ventilator-day through day 7. The protocol group had more documented sedation scores within target range. There were no differences in ICU delirium, SICU or hospital length of stay.
A nursing-driven ASP with criteria for infusion initiation in mechanically-ventilated SICU patients may increase ventilator-free time, maintain patients at the target sedation goal, and reduce opioid and benzodiazepine utilization.
镇痛和镇静方案（ASPs）可减少重症监护病房（ICU）机械通气（MV）的持续时间，但在外科 ICU（SICU）的数据有限。本研究的目的是确定在 SICU 中具有输液起始标准的护理驱动的 ASP 对患者的影响。
一项单中心回顾性研究比较了 MV 开始后第 28 天的无呼吸机天数（VFD28），并在 ASP 实施前后进行了比较。次要终点包括累积阿片类药物和镇静剂需求、镇静水平、谵妄发生率、SICU 和住院时间。
共纳入 132 例患者（每组 66 例）。与对照组相比，方案组的 VFD28 更高（21 天 vs. 14.5 天，p=0.04）。方案组的苯二氮䓬类药物（42.4% vs. 84.8%，p<0.001）和阿片类药物（24.2% vs. 78.8%，p<0.001）输注使用率较低，导致第 7 天前的每台呼吸机每日的累积剂量较低。方案组有更多记录在目标范围内的镇静评分。两组 ICU 谵妄、SICU 和住院时间无差异。
具有输液起始标准的护理驱动的 ASP 可增加机械通气 SICU 患者的无呼吸机时间，使患者保持在目标镇静目标，并减少阿片类药物和苯二氮䓬类药物的使用。
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