多模态七氟醚镇静方案联合心脏停搏后患者目标温度管理可降低谵妄发生率：一项观察性倾向评分匹配研究。

A multimodal sevoflurane-based sedation regimen in combination with targeted temperature management in post-cardiac arrest patients reduces the incidence of delirium: An observational propensity score-matched study.

机构信息

Department of Intensive Care, VieCuri Medical Center, Venlo, P.O. Box 1926, 5900 BX Venlo, The Netherlands.

Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.

出版信息

Resuscitation. 2021 Feb;159:158-164. doi: 10.1016/j.resuscitation.2020.10.042. Epub 2020 Nov 12.

DOI:10.1016/j.resuscitation.2020.10.042

PMID:33189803

Abstract

BACKGROUND

Recent studies suggest that volatile anaesthetics are safe, efficient, and reliable alternatives to the use of intravenous anaesthetics for out-of-hospital cardiac arrest (OHCA) patients admitted to the intensive care unit (ICU). We hypothesised that volatile anaesthetics may reduce the incidence of delirium rather than intravenous sedatives. This retrospective study aimed to investigate whether sevoflurane combined with higher targeted temperature management could decrease the incidence of delirium when compared with intravenous anaesthetics with lower targeted temperature management.

METHODS

Using a propensity score-matched analysis, we retrospectively compared a target temperature management (32-34 °C) method along with intravenous sedation (TTM-33/IV) and a modified target temperature management (34-36 °C) method along with sevoflurane sedation (mTTM-36/sevo). We used the confusion assessment method for the ICU to measure the incidence of delirium. We calculated the time-dependent risk on delirium using the multivariate Cox regression model.

RESULTS

The incidence of delirium was significantly lower (p = 0.001) in OHCA patients of the mTTM-36/sevo group (9/56, 16.1%) than in those of the TTM-33/IV group (25/67, 37.3%). Mechanical ventilation and lengths of stay in the ICU (p < 0.001) and hospital stay (p = 0.04) were shorter in the mTTM-36/sevo group. Patients in the TTM-33/IV group required more midazolam, propofol, and fentanyl. We observed no significant difference in mortality.

CONCLUSION

A multimodal sevoflurane-based sedation regimen together with targeted temperature management resulted in a lower incidence of delirium and a shorter duration for mechanical ventilation and ICU length of stay than did the treatment with intravenous sedation combined with the classical cooling protocol.

摘要

背景

最近的研究表明，挥发性麻醉剂对于因院外心脏骤停（OHCA）而被收入重症监护病房（ICU）的患者来说，是安全、有效和可靠的静脉麻醉替代方案。我们假设挥发性麻醉剂可能会降低谵妄的发生率，而不是静脉镇静剂。本回顾性研究旨在探讨与静脉麻醉联合低目标体温管理相比，七氟醚联合高目标体温管理是否可以降低谵妄发生率。

方法

使用倾向评分匹配分析，我们回顾性比较了目标体温管理（32-34°C）联合静脉镇静（TTM-33/IV）和改良目标体温管理（34-36°C）联合七氟醚镇静（mTTM-36/sevo）的方法。我们使用 ICU 意识模糊评估法来测量谵妄的发生率。我们使用多变量 Cox 回归模型计算谵妄的时间依赖性风险。

结果

mTTM-36/sevo 组（9/56，16.1%）OHCA 患者的谵妄发生率显著低于 TTM-33/IV 组（25/67，37.3%）（p=0.001）。mTTM-36/sevo 组患者的机械通气时间、ICU 住院时间（p<0.001）和住院时间（p=0.04）更短。TTM-33/IV 组患者需要更多的咪达唑仑、丙泊酚和芬太尼。两组患者的死亡率无显著差异。