Fontaine Gabriel V, Der Nigoghossian Caroline, Hamilton Leslie A
Department of Pharmacy, Intermountain Medical Center, Intermountain Healthcare, Salt Lake City, Utah (Dr Fontaine); Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York (Dr Der Nigoghossian); and Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Knoxville, Tennessee(Dr Hamilton).
Crit Care Nurs Q. 2020 Apr/Jun;43(2):232-250. doi: 10.1097/CNQ.0000000000000304.
Sleep plays an important role in the recovery of critically ill patients. However, patients in the intensive care unit (ICU) often suffer sleep disturbances and abnormal circadian rhythms, which may increase delirium and lengthen ICU stay. Nonpharmacologic strategies for preventing and treating sleep disturbances and delirium, such as overnight eye masks and ear plugs, are usually employed first, given the lack of adverse effects. However, a multimodal approach to care including pharmacotherapy may be necessary. Despite the limited available data supporting their use, medications such as melatonin, ramelteon, suvorexant, and dexmedetomidine may promote sleep and improve a variety of patient-centric outcomes such as delirium. This narrative review focuses on these nonbenzodiazepine agents used for sleep in the ICU. Practical application of each of these agents is described for when providers choose to utilize one of these pharmacotherapies to promote sleep or prevent delirium.
睡眠在重症患者的康复过程中起着重要作用。然而，重症监护病房（ICU）的患者经常遭受睡眠障碍和昼夜节律异常，这可能会增加谵妄的发生并延长ICU住院时间。鉴于无不良反应，通常首先采用非药物策略来预防和治疗睡眠障碍及谵妄，如夜间使用眼罩和耳塞。然而，可能需要采用包括药物治疗在内的多模式护理方法。尽管支持使用这些药物的数据有限，但褪黑素、雷美替胺、苏沃雷生和右美托咪定等药物可能会促进睡眠并改善多种以患者为中心的结局，如谵妄。本叙述性综述聚焦于这些用于ICU睡眠的非苯二氮䓬类药物。当医疗人员选择使用这些药物疗法之一来促进睡眠或预防谵妄时，将描述每种药物的实际应用情况。
