2019年冠状病毒病机械通气患者的标准镇静与异氟烷镇静
Standard Sedation and Sedation With Isoflurane in Mechanically Ventilated Patients With Coronavirus Disease 2019.
作者信息
Hanidziar Dusan, Baldyga Kathryn, Ji Christine S, Lu Jing, Zheng Hui, Wiener-Kronish Jeanine, Xie Zhongcong
机构信息
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
Department of Pharmacy, Massachusetts General Hospital, Boston, MA.
出版信息
Crit Care Explor. 2021 Mar 5;3(3):e0370. doi: 10.1097/CCE.0000000000000370. eCollection 2021 Mar.
OBJECTIVES
To describe sedative and analgesic drug utilization in a cohort of critically ill patients with coronavirus disease 2019 and compare standard sedation with an alternative approach using inhaled isoflurane.
DESIGN
This was a retrospective cohort study designed to compare doses of sedatives between ICU patients receiving standard IV sedation and patients receiving mixed sedation including inhaled isoflurane. Data were obtained from electronic medical records.
SETTING
ICU at large academic medical center where mechanical ventilation was delivered with Draeger Apollo (Draeger Medical, Telford, PA) anesthesia machines.
PATIENTS
Consecutive adult patients (≥ 18 yr) with confirmed coronavirus disease 2019 admitted to ICU between April 2, 2020, and May 4, 2020.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Thirty-five mechanically ventilated patients were included in the study, with a mean (sd) age of 59.4 (12.8) years. Twenty-three patients (65.7%) were men. Seventeen patients (48.6%) received standard IV sedation, whereas 18 (51.4%) also received isoflurane. The mean duration of mechanical ventilation (sd) was 23.3 (11.6) days in the standard sedation group and 23.8 (12.5) days in the isoflurane group. Mean (sd) duration of isoflurane exposure was 5.61 (2.99) days, representing 29.1% of total sedation time (sd, 20.4). Cumulative opioid exposure did not differ between the standard sedation and isoflurane sedation groups (mean morphine milligram equivalent 6668 [sd, 1,346] vs 6678 [sd, 2,000] mg). However, the initiation of isoflurane in patients was associated with decreased utilization of propofol (mean daily amount 3,656 [sd, 1,635] before vs 950 [sd, 1,804] mg during isoflurane) and hydromorphone (mean daily amount 48 [sd, 30] before vs 23 [sd, 27] mg).
CONCLUSIONS
In the subjects that received isoflurane, its use was associated with significant decreases in propofol and hydromorphone infusions.
目的
描述2019冠状病毒病重症患者队列中镇静和镇痛药物的使用情况，并比较标准镇静与使用吸入异氟烷的替代方法。
设计
这是一项回顾性队列研究，旨在比较接受标准静脉镇静的ICU患者与接受包括吸入异氟烷在内的混合镇静的患者之间的镇静剂剂量。数据来自电子病历。
地点
大型学术医疗中心的ICU，使用德尔格阿波罗（Draeger Medical，特尔福德，宾夕法尼亚州）麻醉机进行机械通气。
患者
2020年4月2日至2020年5月4日期间入住ICU的确诊2019冠状病毒病的连续成年患者（≥18岁）。
干预措施
无。
测量和主要结果
35例机械通气患者纳入研究，平均（标准差）年龄为59.4（12.8）岁。23例患者（65.7%）为男性。17例患者（48.6%）接受标准静脉镇静，而18例（51.4%）还接受了异氟烷。标准镇静组机械通气的平均（标准差）持续时间为23.3（11.6）天，异氟烷组为23.8（12.5）天。异氟烷暴露的平均（标准差）持续时间为5.61（2.99）天，占总镇静时间的2***.1%（标准差，20.4）。标准镇静组和异氟烷镇静组之间的累积阿片类药物暴露量无差异（平均吗啡毫克当量6668[标准差，1346]对6678[标准差***，2000]毫克）。然而，患者开始使用异氟烷与丙泊酚（异氟烷使用前平均每日用量3656[标准差，1635]毫克，使用期间为950[标准差，1804]毫克）和氢吗啡酮（异氟烷使用前平均每日用量48[标准差，30]毫克，使用期间为23[标准差，27]毫克）的使用量减少有关。
结论
在接受异氟烷的受试者中，其使用与丙泊酚和氢吗啡酮输注量的显著减少有关。
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