Sedation, delirium and psychological distress lets not be deluded 英文参考文献.docVIP

Gri?ths Critical Care 2012,16:109 /content/16/1/109 CO MMENTA RY Sedation, delirium and psychological distress: let’s not be deluded Richard D Gri? ths* See related research by Str?m et al., /content/15/6/R293 venti lation duration and stay compared with those Abstract receiving interrupted sedation in 113 of 140 patients New ways of approaching sedation and analgesia are being considered in our endeavour to improve our management of the ventilated patient. Long-term psychological problems are not insigni?cant and before we can assume bene?t or harm of any new approach we must not delude ourselves by using sampling methods that can miss those patients most at risk. ventilated for more than 48 hours is was without an increase in complication rates, although agitated delirium was more frequent (or observed?) when sedation was not being used. To address the concern that avoiding sedation completely might itself be a psychological stress, they have followed up these patients in a paper published in Critical Care looking at the longer term psychological consequences ey concluded that their protocol does not increase the risk of psychological problems. Can we be con? dent of this assertion from their data? Introduction Short-term expediency and our own perceptions of Or are we at risk of deluding ourselves? Of the 113 distress have usually dominated our sedative approach to mechanical ventilation at the expense of appreciating the patients, after 2 years follow-up 70 had died (62%), leav- ing only a possible 43 patients eligible to study. Twelve long-term consequences of drug exposure, and the e? ect patients did not respond or declined interview so the that unnecessarily prolonged ventilation and immobility data are drawn from just 13 in each gr similar low depression and anxiety scores and no signi- disorders. Studies have shown that sedat