Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Dartmouth Geisel School of Medicine, Hanover, NH, USA.
J Intensive Care Med. 2024 May;39(5):429-438. doi: 10.1177/08850666231210802. Epub 2023 Oct 30.
We aim to assess the impact of the exposure to deep versus light sedation by a critical care transport agency during prehospital and interhospital transport on hospital sedation levels, medication exposure, and outcomes of mechanically ventilated patients. Retrospective cohort review of mechanically ventilated adult critical care transport patients from January 1, 2019, to March 11, 2020, who arrived at an academic medical center. The primary outcome was the correlation of deep sedation during transport with deep sedation within the first 48 h of hospitalization (defined as Richmond Agitation Sedation Scale [RASS] -3 to -5). The secondary outcomes were duration of mechanical ventilation, hospital length of stay, intensive care unit (ICU) length of stay, inpatient mortality, delirium within 48 h, and coma within 48 h. One hundred and ninety-eight patients were included, of whom 183 (92.4%) were deeply sedated during transport which persisted through the first 48 h of hospital care. Deep sedation during transport was not correlated with deep sedation in the hospital within the first 48 h (OR 2.41; 95% CI, 0.48-12.02). There was no correlation with hospital length of stay, ICU length of stay, duration of mechanical ventilation, or hospital mortality. Deep sedation during transport was not correlated with delirium or coma within the first 48 h of hospitalization. There was a negligible correlation between final transport RASS and initial hospital RASS which did not differ based on the lapsed time from handoff (<1 h corr. coeff. 0.23; ≥1 h corr. coeff. 0.25). Deep sedation was observed during critical care transport in this cohort and was not correlated with deep sedation during the first 48 h of hospitalization. The transition of care between the transport team and the hospital team may be an opportunity to disrupt therapeutic momentum and re-evaluate sedation decisions.
我们旨在评估在院前和院间转运期间，由重症监护转运机构进行的深度与浅度镇静对入住医院时镇静水平、药物暴露和机械通气患者结局的影响。这是一项回顾性队列研究，纳入了 2019 年 1 月 1 日至 2020 年 3 月 11 日期间入住一家学术医疗中心的成年重症监护转运患者，这些患者均接受机械通气。主要结局是转运期间的深度镇静与住院前 48 小时内的深度镇静（定义为 Richmond 躁动镇静量表 [RASS]-3 至-5）之间的相关性。次要结局包括机械通气时间、住院时间、重症监护病房（ICU）入住时间、住院死亡率、48 小时内谵妄和 48 小时内昏迷。共纳入 198 例患者，其中 183 例（92.4%）在转运期间和住院前 48 小时内深度镇静。转运期间的深度镇静与住院前 48 小时内的深度镇静无相关性（OR 2.41；95%CI，0.48-12.02）。与住院时间、ICU 入住时间、机械通气时间或住院死亡率均无相关性。转运期间的深度镇静与住院前 48 小时内的谵妄或昏迷也无相关性。转运时的最终 RASS 与入院时的初始 RASS 之间存在微弱的相关性，而交接后时间（<1 h 的相关系数 0.23；≥1 h 的相关系数 0.25）对其并无影响。在该队列中，观察到重症监护转运期间存在深度镇静，但与住院前 48 小时内的深度镇静无关。转运团队和医院团队之间的交接可能是打破治疗势头并重新评估镇静决策的机会。
