Sedation of Patients in the Intensive Care Unit课件.pptVIP

下载本文档

0
0
约9.3千字
约 36页
2018-06-02 发布于河南
举报
版权申诉

Sedation of Patients in the Intensive Care Unit课件.ppt

1、本文档共36页，可阅读全部内容。
2、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。
3、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击这里二次下载。
4、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
5、该文档为VIP文档，如果想要下载，成为VIP会员后，下载免费。
6、成为VIP后，下载本文档将扣除1次下载权益。下载后，不支持退款、换文档。如有疑问请联系我们。
7、成为VIP后，您将拥有八大权益，权益包括：VIP文档下载权益、阅读免打扰、文档格式转换、高级专利检索、专属身份标志、高级客服、多端互通、版权登记。
8、VIP文档为合作方或网友上传，每下载1次，网站将根据用户上传文档的质量评分、类型等，对文档贡献者给予高额补贴、流量扶持。如果你也想贡献VIP文档。上传文档

Copyright restrictions may apply. Riker, R. R. et al. JAMA 2009;301:489-499. Safety Outcomes During Treatment With Dexmedetomidine vs Midazolam Cost minimization Median cost savings of $9700 (95% CI $2300-$17000) 2/3 from decreased ICU LOS and 1/3 from decreased MV) Dex: $50 for 200 mcg vial Midazolam $1.56 for 5 mg vial Dasta CCM Feb 2010 Combining sedation and ventilator weaning protocols 336 MV patients in 4 hospitals Sedation awakening trial (SAT) + SBT vs usual sedation + SBT Non-protocolized sedation practice Main outcome: days alive and free of MV up to 28th day Girard Lancet 371:126 2008 Hooper. Critical Care Clinics - 25 (July 2009) Results: ABC Trial SAT + SBT = more Ventilator-free days 15 v 12 (p =0.02) Less days in ICU: 9 v 13 Less coma but more self-extubations Decreased risk of dying up to 1 yr Hazard ratio 0.68 NNT = 7 Girard Lancet 371:126 2008 Non-traditional therapies to manage symptoms of MV patients Patient-controlled sedation Dexmedetomidine in standard PCA pump Initiate at 0.2 mcg/kg/hr Patients can self-administer 0.25 mcg/kg boluses up to 3 times/hr Adjust basal infusion hourly based on amount of bolus doses Music therapy RCT in MV patients Chlan, RN, PhD; Tracy RN, PhD; Skaar, PharmD; Weinert, MD, MPH * * * * * Sedation of Patients in the Intensive Care Unit Craig Weinert, MD, MPH PACCS Jan 2010 Indications and Goals for Sedative Therapy Facilitate mechanical ventilation Create anxiolysis, analgesia, amnesia Decrease oxygen consumption Reduce dyspnea Indications and Goals for Sedative Therapy Prevent patient self-injury “Rest” patient for weaning trials Induce sleep Create patient unawareness Improve long-term psychiatric outcomes (?) Permit delivery of efficient care Reduce nursing stress Ensure nursing safety Increase family acceptance of ICU care Weinert, et al. AJCC. 2001; 10:156 THE PATIENT IS HERE! Benzodiazepines GABA receptor agonists Midazolam: Changes from water- to lipid-soluble in bloodstream so rapid-acting Liver metabo