ICUSYNDROME.ppt

非药物干预 加强定向 感觉输入 激活认知 加强运动 加强昼夜节律 改善环境 助眠 控制夜间噪音、灯光 Pun B T , Ely E W. Chest 2007;132:624-636 Managing ICU Delirium Look for it Communication between nursing and MDs Identify and treat correctable risk factors Optimize non-pharmacologic interventions Goal-oriented sedation with daily wake-ups Pharmacologic intervention Daily Wake-Ups Kress et al, NEJM 2000: 128 vented MICU patients randomized to daily awakening vs usual care AND midazolam vs propofol (all patients received morphine) Infusions off until following commands or agitated Shorter time on vent (4.9 vs 7.3 days) Shorter time in ICU (6.4 vs 9.9 days) Fewer diagnostic tests for mental status No difference in complications or PTSD No difference between propofol and midazolam Kress JP. NEJM 2000. 342:1471-1477 Sessler CN. Crit Care Clin. 2009. 25: 489-513 Dexmedetomidine 1. 镇静、镇痛、抗交感 2. 无呼吸抑制 、完美的睡眠 3. 减少谵妄的发生率 Dexmedetomidine Dexmedetomidine vs Lorazepam Pratik P Pandharipande, E Wesley Ely for the MENDS investigators. Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial. Critical Care. 2010, 14:R38 Dexmedetomidine vs Lorazepam Maximizing Efficacy of Targeted Sedation and Reducing Neurological Dysfunction (MENDS) trial Dexmedetomidine vs Lorazepam Pratik P Pandharipande, E Wesley Ely for the MENDS investigators. Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial. Critical Care. 2010, 14:R38 probability of survival during the first 28 days We suggest that in adult ICU patients with delirium unrelated to alcohol or benzodiazepine withdrawal, continuous IV infusions of dexmedetomidine rather than benzodiazepine infusions be administered for sedation in order to reduce the duration of delirium in these patients （+2B） Crit Care Med . 2013; 41:263 - 306 药物干预 H