Shehabi城市巡回演讲·广州站-英文版.pptxVIP

Sedation Practice in Intensive Care EvaluationEarly Goal Directed Sedation ;The 2013 SCCM Guidelines;Deep vs Light SedationTreggiari et al CCM 2007;How often is light sedation achieved?;How often is light sedation achieved?;How often and When is light sedation NOT achieved?;Light sedation is NOT achieved for up to 72 hours after ventilation;EARLY Deep sedation may be harmfulIndependently predicts time to extubation;EARLY Deep sedation may be harmfulIndependent predictor of 6 month mortality;How bad is deep sedation?;Protocolized Sedation and Analagesia ;Skrobik 2010 An Analgesia ;EGDS, Rationale ;Key Elements Early Goal Directed Sedation ;Key Trials of Sedative AgentsDexmedetomidine vs Midazolam vs Propofol; ;Light sedation RASS -1 to 0;Why dexmedetomidine for EGDS?;EGDS is a bridge to the future;EGDS is a combination strategy; EGDS is fashionable ;Patient is mechanically ventilated;Is Early Goal Directed Sedation Feasible? ;EGDS – ANZ Pilot RCTCrit Care Med Aug 2013;Time spent in light sedation first 48 hours EGDS vs. STDS ;Patients achieving light sedationduring the first 7 study days ;Is Early Goal Directed Sedation Feasible? ;EGDS – Malaysian Pilot RCT;Outcomes;Study Algorithm;No response to voice or physical stimulation;Primary outcomeRASS achieved in the 48 hours;Combined DataRASS achieved in First 48 hours ;EGDS Pilots Main outcomes; Sedative and Analgesic AgentsCummulative dose and Time Rx;Relevant ICU outcomes;What we learned form EGDS ;Conclusion ; Supported by a Project Grant NHMRC 2012Endorsed by Australian New Zealand Intensive Care Society Clinical Trials Group;Dexmedetomidine, a2 receptors, and the CNS;;Mode of action;Adrenergic effects of dexmedetomidine;BP and HR effects;Sedation and analgesia effects;Memory and Pain ;Respiratory effects; Synergy with other agents;Prolonged infusion of dexmedetomidineKinetics (MIDEX and PRODEX) 527 patients;Prolonged infusion of dexmedetomidinePopulation Kinetics 643 patients;52;O