Vagionas Dimitrios, Vasileiadis Ioannis, Rovina Nikoletta, Alevrakis Emmanouil, Koutsoukou Antonia, Koulouris Nikolaos
Intensive Care Unit, 1st Department Respiratory Medicine, "Sotiria" Hospital, National and Kapodistrian University of Athens, Greece.
4th Department of Respiratory Medicine, "Sotiria" Hospital, National and Kapodistrian University of Athens, Greece.
Anaesthesiol Intensive Ther. 2019;51(5):380-389. doi: 10.5114/ait.2019.90921.
Daily sedation interruption (DSI) is a method used since the beginning of the millennium to streamline sedation in critically ill patients under mechanical ventilation and improve clinical outcomes. The purpose was to assess whether there is a correlation between DSI and weaning from mechanical ventilation. We designed a literature review via searching PubMed, UpToDate and Google Scholar for relevant key terms from inception until March 2019. Literature retrieved included nine randomized controlled trials. When compared to usual practice, it is superior in terms of duration of mechanical ventilation, stay in the intensive care unit, hospitalization, adverse effect occurrence and total cost of therapy. Comparison with other sedation protocols produces conflicting results. DSI, and protocolized sedation in general, are safe methods to perform to facilitate earlier weaning and improved clinical outcomes. Future research should focus on minimizing bias by conducting double-blinded studies and studying different patient subgroups.
每日镇静中断(DSI)是自千禧年伊始便被采用的一种方法,用于优化机械通气的重症患者的镇静并改善临床结局。目的是评估DSI与机械通气撤机之间是否存在相关性。我们通过在PubMed、UpToDate和谷歌学术上搜索从起始至2019年3月的相关关键词来设计一项文献综述。检索到的文献包括九项随机对照试验。与常规做法相比,其在机械通气时长、重症监护病房停留时间、住院时间、不良反应发生情况及治疗总成本方面更具优势。与其他镇静方案相比产生了相互矛盾的结果。总体而言,DSI以及规范化镇静是有助于更早撤机和改善临床结局的安全方法。未来的研究应聚焦于通过开展双盲研究和研究不同患者亚组来尽量减少偏倚。