Sedation and renal impairment in critically ill patients a post hoc analysis of a randomized trial 英文参考文献.docVIP

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Sedation and renal impairment in critically ill patients a post hoc analysis of a randomized trial 英文参考文献.doc

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Sedation and renal impairment in critically ill patients a post hoc analysis of a randomized trial 英文参考文献

Str?metal.CriticalCare2011,15:R119 /content/15/3/R119 RESEARCH OpenAccess Sedationandrenalimpairmentincriticallyill patients:aposthocanalysisofarandomizedtrial ThomasStr?m*,RasmusRJohansen,JensOPrahlandPalleToft Abstract Introduction:Notsedatingcriticallyillpatientsreducesthetimepatientsreceivemechanicalventilation,decreases thetimeintheintensivecaredepartmentandreducesthetotalhospitallengthofstay.Wehypothesizedthatno sedationimproveshemodynamicstability,decreasestheneedforvasoactivedrugs,diminishestheneedforextra fluidsandlowerstheriskofacutekidneyinjury. Methods:Weperformedanevaluationonthedatabasefromourprevioustrialof140patientsrandomizedto eithernosedationvs.sedationwithadailyinterruptionofsedatives.Atotalof113patientswereincludedinthe previousstatisticalanalysis.Tenpatientshadpre-existingrenalimpairmentsandwereexcluded.Datawere collectedfromobservationalcardsandbloodsamples. Results:Atotalof103patientswereincludedinthisretrospectivereview.Weregisteredanincreasedurineoutput inthegroupreceivingnosedationcomparedtothesedatedcontrolgroup(1.15ml/kg/hour(0.59to1.53)vs.0.88 ml/kg/hour(0.052to1.26),P=0.03).Inadditionwesawadecreaseinthenumberofpatientswithrenal impairmentaccordingtotheRIFLEclassification(indicatingRiskofrenaldysfunction;Injurytothekidney;Failureof kidneyfunction,LossofkidneyfunctionandEnd-stagekidneydisease)inthegroupreceivingnosedation comparedtothesedatedcontrolgroup(25(51%)vs.41(76%),P=0.012).Thedifferenceinthetwogroupswith respecttomeanarterialbloodpressure,fluidbalanceanduseofvasoactivedrugswasnotsignificant. Conclusions:Anosedationstrategytopatientsundergoingmechanicalventilationincreasestheurineoutputand decreasesthenumberofpatientswithrenalimpairments. Trialregistration:ClinicalTregistrationnumberNC Introduction Kressandcolleagues showedthatadailyinterruption Sedation is used in critically ill patients receiving ofsedativesreducedthetimepatientsreceivemechanical mechanicalventilationtobringthepatientscomfortand ventilationa