Pushing the envelope to reduce sedation in critically ill patients 英文参考文献.docVIP

Ogundele and Yende Critical Care 2010,14:339 /content/14/6/339 JOURNAL CLU B CRITIQUE Pushing the envelope to reduce sedation in critically ill patients Olufunmilayo Ogundele and Sachin Yende* Expanded Abstract Citation Strom T, Martinussen T, Toft P: A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomized trial. Lancet 2010, 375:475-480 [1]. the study and statistical analysis. Patients receiving no sedation had signi? cantly more days without ventilation (n = 55; mean 13.8 days, SD 11.0) than did those receiving interrupted sedation (n = 58; mean 9.6 days, SD 10.0; mean di? erence 4.2 days, 95% CI 0.3–8.1; p = 0.0191). No sedation was also associated with a shorter stay in the inten sive care unit (HR 1.86, 95% CI 1.05–3.23; Background Standard treatment of critically ill patients undergoing p = 0.0316), and, for the ? rst 30 days studied, in hospital mechanical ventilation is continuous sedation. Daily (3.57, 1.52–9.09; p = 0.0039), than was interrupted interruption of sedation has a bene? cial e? ect, and in the sedation. No di? erence was recorded in the occurrences general intensive care unit of Odense University Hospital, Denmark, standard practice is a protocol of no sedation. of accidental extubations, the need for CT or MRI brain scans, or ventilator-associated pneumonia. Agitated We aimed to establish whether duration of mechanical delirium was more frequent in the intervention group ventilation could be reduced with a protocol of no seda- tion versus daily interruption of sedation. than in the control group (n = 11, 20% vs. n = 4, 7%; p = 0.0400). Methods Interpretation Of 428 patients assessed for eligibility, we enrolled 140 No sedation of critically ill patients receiving mechanical critically ill adult patients who were undergoing mech- ventilati