原创力文档sedation and renal impairment in critically ill patients a post hoc analysis of a randomized trial镇静和危重患者的肾功能损害的事后分析随机试验.pdfVIP
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sedation and renal impairment in critically ill patients a post hoc analysis of a randomized trial镇静和危重患者的肾功能损害的事后分析随机试验
Strøm et al. Critical Care 2011, 15:R119
/content/15/3/R119
RESEARCH Open Access
Sedation and renal impairment in critically ill
patients: a post hoc analysis of a randomized trial
*
Thomas Strøm , Rasmus R Johansen, Jens O Prahl and Palle Toft
Abstract
Introduction: Not sedating critically ill patients reduces the time patients receive mechanical ventilation, decreases
the time in the intensive care department and reduces the total hospital length of stay. We hypothesized that no
sedation improves hemodynamic stability, decreases the need for vasoactive drugs, diminishes the need for extra
fluids and lowers the risk of acute kidney injury.
Methods: We performed an evaluation on the database from our previous trial of 140 patients randomized to
either no sedation vs. sedation with a daily interruption of sedatives. A total of 113 patients were included in the
previous statistical analysis. Ten patients had pre-existing renal impairments and were excluded. Data were
collected from observational cards and blood samples.
Results: A total of 103 patients were included in this retrospective review. We registered an increased urine output
in the group receiving no sedation compared to the sedated control group (1.15 ml/kg/hour (0.59 to 1.53) vs. 0.88
ml/kg/hour (0.052 to 1.26), P = 0.03). In addition we saw a decrease in the number of patients with renal
impairment according to the RIFLE classification (indicating Risk of renal dysfunction; Injury to the kidney; Failure of
kidney function, Loss of kidney function and End-stage kidney disease) in the group receiving no sedation
compared to the sedated control group (25 (51%) vs. 41 (76%), P = 0.012). The difference in the two groups with
respect to mean arterial blood pressure, fluid balance and use of vasoactive drugs was not significant.
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