Poole Brian R, Reese Zachary A, Dechen Tenzin, Tocci Noah, Elsamadisi Pansy, Holland Susan, Hayes Margaret M, Stevens Jennifer P
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah, Salt Lake City, UT.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Crit Care Explor. 2020 Jun 18;2(6):e0147. doi: 10.1097/CCE.0000000000000147. eCollection 2020 Jun.
To identify the prevalence of and evaluate factors associated with down-titration of sedation in patients receiving neuromuscular blockade.
Retrospective cohort study.
Tertiary care teaching hospital in Boston, MA.
All patients over 18 years old admitted to the medical, surgical, or cardiac ICUs from 2013 to 2016, and who received cisatracurium for at least 24 hours.
We examined patients for whom sedation was decreased despite accompanying ongoing neuromuscular blockade administration.
Of the 300 patients who met inclusion criteria (39% female, mean age of 57 yr old), 168 (56%) had sedation down-titrated while receiving neuromuscular blockade with a mean decrease in sedation dose of 18.7%. Factors associated with down-titration of sedation were bispectral index usage (90/168 [53.6%] vs 50/168 [29.8%] patients; < 0.01; odds ratio, 1.82; 1.12-2.94), and bolus dose of neuromuscular blockade prior to continuous infusion (138/168 [82.1%] vs 79/168 [47.0%] patients; < 0.0001).
Down-titration of sedation among mechanically ventilated patients receiving neuromuscular blockade was common and was correlated with bispectral index monitor usage. Clinicians should be aware of the limitations of quantitative electroencephalography monitoring devices and recognize their potential to cause inappropriate down-titration of sedation. Substantial opportunity exists to improve the quality of care of patients receiving neuromuscular blockade through development of guidelines and standardized care pathways.
确定接受神经肌肉阻滞剂治疗的患者中镇静药物减量的发生率，并评估与之相关的因素。
回顾性队列研究。
马萨诸塞州波士顿的三级护理教学医院。
2013年至2016年入住内科、外科或心脏重症监护病房且年龄超过18岁、接受顺式阿曲库铵治疗至少24小时的所有患者。
我们检查了那些尽管持续给予神经肌肉阻滞剂但镇静药物仍减量的患者。
在符合纳入标准的300例患者中（女性占39%，平均年龄57岁），168例（56%）在接受神经肌肉阻滞剂治疗期间镇静药物减量，镇静剂量平均减少18.7%。与镇静药物减量相关的因素有脑电双频指数的使用（90/168 [53.6%] 例患者 vs 50/168 [29.8%] 例患者；P<0.01；比值比，1.82；1.12 - 2.94），以及持续输注前神经肌肉阻滞剂的推注剂量（138/168 [82.1%] 例患者 vs 79/168 [47.0%] 例患者；P<0.0001）。
接受神经肌肉阻滞剂治疗的机械通气患者中，镇静药物减量情况常见，且与脑电双频指数监测仪的使用相关。临床医生应意识到定量脑电图监测设备的局限性，并认识到其可能导致镇静药物不适当减量。通过制定指南和标准化护理路径，存在显著机会来改善接受神经肌肉阻滞剂治疗患者的护理质量。
