Watling S M, Dasta J F, Seidl E C
Critical Care Department of Pharmacy, University of Missouri, Columbia 65212, USA.
Ann Pharmacother. 1997 Feb;31(2):148-53. doi: 10.1177/106002809703100202.
To solicit practitioner-perceived opinions regarding current sedative/analgesic/paralytic practice including drug selection, admixture methods, and methods of assessing patient response to therapy via surgery tool; and to assess sedative/pain/paralytic drug use patterns including dosage, route selection, and combination therapy by collecting actual drug administration data from multiple centers.
Respondents completed a survey and collected drug administration data for 5 consecutive days in the intensive care unit (ICU) in which they practiced.
One hundred thirty-eight members of the Society of Critical Care Medicine Clinical Pharmacology and Pharmacy section and the Critical Care Practice Research Network of the American College of Clinical Pharmacy agreed to participate in the study.
Fifty-one percent of the participants completed surveys, and 45% returned drug administration data collection forms. Patients received sedative/pain/paralytic therapy 62% of the 5 days studied. The most frequently received drugs were opiates, followed by benzodiazepines. Intermittent intravenous injection, oral/enteral, and continuous infusion methods were used in most patients. Combination therapy was used 25% of the time, with benzodiazepine/opiate combinations used most often (46%). Administration protocols were rarely used. Paralytic agents were occasionally administered without sedative/pain therapy.
Patients received these agents during the majority of their ICU stay. Multicenter drug use data suggested a preference for opiate and benzodiazepine therapy. Many centers used continuous infusion therapy despite minimal pharmacokinetic/pharmacodynamic information on ICU patients. Further studies are needed to standardize end points, as well as obtain both pharmacokinetic/pharmacodynamic and stability data in ICU patients.
通过手术工具征求从业者对当前镇静/镇痛/麻痹治疗实践的看法，包括药物选择、混合方法以及评估患者对治疗反应的方法；并通过收集多个中心的实际用药数据来评估镇静/镇痛/麻痹药物的使用模式，包括剂量、给药途径选择和联合治疗。
受访者完成一项调查，并收集他们工作的重症监护病房（ICU）中连续5天的用药数据。
危重病医学临床药理学和药学分会以及美国临床药师学院危重病实践研究网络的138名成员同意参与该研究。
51%的参与者完成了调查，45%的人返回了用药数据收集表。在研究的5天中，62%的患者接受了镇静/镇痛/麻痹治疗。最常使用的药物是阿片类药物，其次是苯二氮䓬类药物。大多数患者采用间歇性静脉注射、口服/肠内和持续输注方法。联合治疗占25%的时间，最常使用的是苯二氮䓬类/阿片类药物联合（46%）。很少使用给药方案。麻痹药物偶尔在没有镇静/镇痛治疗的情况下使用。
患者在ICU住院期间的大部分时间都接受了这些药物治疗。多中心用药数据表明，人们偏爱阿片类药物和苯二氮䓬类药物治疗。尽管关于ICU患者的药代动力学/药效学信息很少，但许多中心仍使用持续输注治疗。需要进一步研究来规范终点指标，并获取ICU患者的药代动力学/药效学和稳定性数据。
