非镇静对危重症幸存者认知功能的影响。

Effect of Nonsedation on Cognitive Function in Survivors of Critical Illness.

机构信息

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.

出版信息

Crit Care Med. 2020 Dec;48(12):1790-1798. doi: 10.1097/CCM.0000000000004573.

DOI:10.1097/CCM.0000000000004573

PMID:33048901

Abstract

OBJECTIVES

Critical illness can cause severe cognitive impairments. The objective of this trial was to assess the effect of nonsedation versus sedation with a daily wake-up call during mechanical ventilation on cognitive function in adult survivors of critical illness.

DESIGN

Single-center substudy of the multicenter, randomized Non-sedation Versus Sedation With a Daily Wake-up Trial in Critically Ill Patients Receiving Mechanical Ventilation trial. Three months after ICU-discharge participants were tested for cognitive function by a neuropsychologist.

SETTING

Mixed 14-bed ICU in teaching hospital.

PATIENTS

A total of 205 critically ill, orally intubated, and mechanically ventilated adults.

INTERVENTIONS

Patients were randomized within the first 24 hours from intubation to either nonsedation with sufficient analgesia or light sedation with a daily wake-up call during mechanical ventilation.

MEASUREMENTS AND MAIN RESULTS

A total of 118 patients survived to follow-up and 89 participated (75%). The participating survivors in the two groups did not differ regarding baseline data or premorbid cognitive impairments. Sedated patients had received more sedatives, whereas doses of morphine and antipsychotics were equal. The primary outcome was that no significant difference was found in the number of patients with mild/moderate cognitive impairments (six nonsedated patients vs four sedated patients) or severe cognitive impairments (16 nonsedated patients vs 17 sedated patients; p = 0.71). Secondary outcomes were cognitive test scores, and no differences were found between the scores in nonsedated and sedated patients. Hypothetical worst case scenarios where all patients, who had not participated in follow-up assessment, were assumed to have severe cognitive impairments were analyzed, but still no difference between the groups was found. We found more patients with delirium in the sedated group (96% vs 69% of patients; p = 0.002) and increased duration of delirium in sedated patients (median 5 vs 1 d; p < 0.001). Delirium subtypes were equally distributed between the groups, with hypoactive delirium most frequent (61%), followed by mixed delirium (39%).

CONCLUSIONS

Nonsedation did not affect cognitive function 3 months after ICU-discharge.

摘要

目的

危重病可导致严重认知障碍。本试验的目的是评估在机械通气期间进行每日唤醒与镇静相比对重症患者机械通气后幸存者认知功能的影响。

设计

多中心随机非镇静与镇静每日唤醒试验的单中心亚研究。在 ICU 出院后 3 个月，由神经心理学家对参与者进行认知功能测试。

设置

教学医院的混合 14 床 ICU。

患者

共 205 名危重病、经口插管和机械通气的成年人。

干预措施

在插管后 24 小时内，患者被随机分为非镇静组（充分镇痛）或镇静组（机械通气期间每日唤醒）。

测量和主要结果

共有 118 名患者存活至随访，其中 89 名（75%）患者参与。两组参与者在基线数据或发病前认知障碍方面无差异。镇静组患者接受了更多的镇静剂，而吗啡和抗精神病药物的剂量相等。主要结局是，在轻度/中度认知障碍患者（6 名非镇静患者 vs 4 名镇静患者）或重度认知障碍患者（16 名非镇静患者 vs 17 名镇静患者）数量上，两组间无显著差异（p = 0.71）。次要结局为认知测试评分，非镇静组和镇静组之间无差异。假设所有未参加随访评估的患者均为重度认知障碍，对最坏情况进行了分析，但两组间仍无差异。我们发现镇静组的谵妄患者更多（96% vs 69%的患者；p = 0.002），镇静组的谵妄持续时间更长（中位数 5 天 vs 1 天；p < 0.001）。两组间谵妄亚型分布均匀，以低活动型谵妄最常见（61%），其次是混合型谵妄（39%）。