Department of Anesthesiology and Intensive Care, Lillebaelt Hospital Kolding, University Hospital of Southern Denmark, Kolding, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Acta Anaesthesiol Scand. 2020 Sep;64(8):1136-1143. doi: 10.1111/aas.13648. Epub 2020 Jun 18.
Critical illness can cause post-traumatic stress and impaired mental health. The NONSEDA trial was a Scandinavian multicenter RCT, assessing non-sedation versus sedation with a daily wake-up call during mechanical ventilation in critically ill adults. The aim of this substudy was to assess the effect of non-sedation on post-traumatic stress and mental health.
This substudy is based on all participating patients from a single NONSEDA trial site (Kolding, Denmark). Patients were randomized to sedation or non-sedation within the first 24 hours of mechanical ventilation. Three months after ICU discharge survivors were examined by a neuropsychologist for post-traumatic stress, anxiety and depression, and filled out the SF-36 questionnaire regarding quality of life.
The two groups of survivors were similar with regard to baseline characteristics, length of admission and mechanical ventilation. Sedated patients received more propofol and midazolam. Doses of morphine and haloperidole were equal.
the number of patients with post-traumatic stress disorder did not differ between groups (non-sedated: 2 patients vs sedated: 0, P = .23).
there were no differences between groups in Beck Anxiety Index (median, non-sedated: 0 vs sedated: 0, P = .62), Beck Depression Index (median, non-sedated: 7 vs sedated: 4, P = .24), SF-36 mental component score (mean, non-sedated: 46.7 vs sedated: 47.5, P = .73) or number of patients with symptoms of post-traumatic stress (8 in both groups, P = .89).
Levels of PTSD, anxiety and depression and quality of life regarding mental health were similar between the non-sedated and sedated group.
危重病可导致创伤后应激和精神健康受损。NONSEDA 试验是一项斯堪的纳维亚多中心 RCT，评估了机械通气期间重症成人每日唤醒而非镇静的效果。本亚研究的目的是评估非镇静对创伤后应激和精神健康的影响。
本亚研究基于来自单一 NONSEDA 试验地点（丹麦的科灵）的所有参与患者。患者在机械通气的头 24 小时内被随机分配到镇静或非镇静组。在 ICU 出院后 3 个月，幸存者由神经心理学家检查创伤后应激、焦虑和抑郁，并填写 SF-36 问卷，评估生活质量。
两组幸存者在基线特征、住院时间和机械通气方面相似。镇静组患者接受了更多的丙泊酚和咪达唑仑。吗啡和氟哌啶醇的剂量相等。
两组创伤后应激障碍患者的数量无差异（非镇静组：2 例与镇静组：0 例，P=0.23）。
两组贝克焦虑指数（中位数，非镇静组：0 与镇静组：0，P=0.62）、贝克抑郁指数（中位数，非镇静组：7 与镇静组：4，P=0.24）、SF-36 心理成分评分（均值，非镇静组：46.7 与镇静组：47.5，P=0.73）或有创伤后应激症状的患者人数（两组均为 8 例，P=0.89）均无差异。
非镇静组和镇静组的 PTSD、焦虑和抑郁水平以及心理健康相关的生活质量相似。
