Rabatin sedation China 2006课件.ppt

Treating Pain and Agitation in Patients Receiving Mechanical Ventilation (MV);Learning Objectives;Case;Clinical Practice Guidelines;Learning Objectives;Learning Objectives;Agents use to treat pain ;Agents use to treat pain ;Agents use to treat agitation;Agents use to treat agitation;Agents use to treat agitation;Agents use to treat agitation;Learning Objectives;Pain Scale: 1-10 numerical rating scale Visual analogue scale Faces scale FLACC pain scale Use objective scale appropriate to patient population ;Pain Scale: Faces scale ;Ramsay Sedation Scale: 1 – anxious, agitated or restless 2 - cooperative, oriented, and tranquil 3 - responsive to commands only 4 - asleep, with a brisk response to a light glabellar tap or loud sound 5 - asleep, with a sluggish response to a light glabellar tap or loud sound 6 - asleep, with no response to a light glabellar tap or loudsound Ramsay MAE, BMJ 1974;2:656-9;Richmond Agitation-Sedation Scale (RASS) +4 Combative +3 Very Agitated +2 Agitated +1 Restless 0 Alert and Calm -1 Drowsy -2 Light sedation -3 Moderate -4 Deep sedation -5 Unarousable ;Learning Objectives;Kollef et al Chest 1998: Continuous vs intermittent sedation Increased duration of MV increase ICU LOS ;Kress et al NEJM 1998: Daily interruption of sedation Decrease duration of mechanical ventilation Decrease ICU length of stay No increased number of self extubations ;Algorithm for Patients Requiring mechanical ventilation for 48 hrs;Algorithm for Patients Requiring mechanical ventilation for 48 hrs;Summary