Hatozaki Chie, Sakuramoto Hideaki, Ouchi Akira, Shimojo Nobutake, Inoue Yoshiaki
Intensive Care Unit, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.
Department of Critical care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Fukuoka, Japan.
SAGE Open Nurs. 2023 Oct 17;9:23779608231206761. doi: 10.1177/23779608231206761. eCollection 2023 Jan-Dec.
The international guidelines recommend light sedation management for patients receiving mechanical ventilation. One of the benefits of light sedation management during mechanical ventilation is the preservation of spontaneous breathing, which leads to improved gas-exchange and patient outcomes. Conversely, recent experimental animal studies have suggested that strong spontaneous breathing effort may cause worsening of lung injury, especially in severe lung injury cases. The association between depth of sedation and patient outcomes may depend on the severity of lung injury.
This study aimed to describe the patients' clinical outcomes under deep or light sedation during the first 48 h of mechanical ventilation and investigate the association of light sedation on patient outcomes for each severity of lung injury.
The researchers performed a retrospective observational study at a university hospital in Japan. Patients aged ≥20 years, who received mechanical ventilation for at least 48 h were enrolled.
A total of 413 patient cases were analyzed. Light sedation was associated with significantly shorter 28-day ventilator-free days compared with deep sedation in patients with severe lung injury (0 [IQR 0-5] days vs. 16 [0-19] days, = .038). In the groups of patients with moderate and mild lung injury, the sedation depth was not associated with ventilator-free days. After adjusting for the positive end-expiratory pressure and APACHE II score, it was found that light sedation decreased the number of ventilator-free days in patients with severe lung injury (-10.8 days, 95% CI -19.2 to -2.5, = .012).
Early light sedation for severe lung injury may be associated with fewer ventilator-free days.
国际指南推荐对接受机械通气的患者进行轻度镇静管理。机械通气期间轻度镇静管理的益处之一是保留自主呼吸，这会改善气体交换和患者预后。相反，最近的实验动物研究表明，强烈的自主呼吸努力可能会导致肺损伤恶化，尤其是在严重肺损伤病例中。镇静深度与患者预后之间的关联可能取决于肺损伤的严重程度。
本研究旨在描述机械通气最初48小时内深度或轻度镇静下患者的临床结局，并调查轻度镇静对每种肺损伤严重程度患者预后的影响。
研究人员在日本一家大学医院进行了一项回顾性观察研究。纳入年龄≥20岁、接受机械通气至少48小时的患者。
共分析了413例患者病例。在严重肺损伤患者中，与深度镇静相比，轻度镇静与28天无呼吸机天数显著缩短相关（0[四分位间距0 - 5]天对16[0 - 19]天，P = 0.038）。在中度和轻度肺损伤患者组中，镇静深度与无呼吸机天数无关。在调整呼气末正压和急性生理与慢性健康状况评分系统II评分后，发现轻度镇静减少了严重肺损伤患者的无呼吸机天数（-10.8天，95%置信区间-19.2至-2.5，P = 0.012）。
对严重肺损伤患者早期进行轻度镇静可能与无呼吸机天数减少有关。
