浅镇静,要多浅？.pptVIP

浅镇静,要多浅?  But what see these days are paralyzed, sedated patients, Lying without motion, appearing to be dead, except for the Monitors that tell me otherwise Thomas L. Petty a young polio patient. Copenhagen 1952  当今镇静所关注的问题 Special Article Clinical Practice Guidelines for the management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit Juliana Barr, MD, FCCM: Gilles L. Fraser, PharmD, FCCM Kathleen Puntillo, RN, PhD, FAAN, FCCI E. Wesley Ely, MD, MPH, FACP, FCCM; Celine Gelinas, RN, PhD; Joseph E Dasta, MSc, FCCM, FC(  Maintaining lighter levels of sedation in ICU patients is associated with improved clinical outcomes(B); light level of sedation should be maintained in these patients(1B) 成人cU患者维持轻度镇静可改善临床预后 目标:轻度镇静 2002需要根据患者情况设置镇静目标 Suggest using Analgesia-first sedation(2B) Suggest using non-benzodiazepines rather than benzodiazepir Q infusions for sedation ( 2B ) Use sedation protocols and daily checklists to integrate and to facilitate management z of pain, sedation, and delirium in ICU patients (1B)  Rationales for light Sedation 对成人IcU患者,维持轻度镇静可改善临床预后 (如缩短机械通气时间及CU住院时间)(B)  Benefit from light sedation ●机械通气时间 ●CU住院时间 死亡率 也可能降低谵亡的发生率  Lighter Level of Sedation Protocol vs non-protocol-directed sedation Similar rate continuous infusion(40.7% vs 41.5%o)but shorter duration(3.5 vs 5.6 days, p=0.003) Median duration of MV 55.9 vs 117.0 hrs, P=.008 ICU LOS(5.7 vS 7.5 days; P=.013) Hospital LOS (14.0 vs 19.9; p.001) Lower tracheostomy rate(6.2%o vs 13. 2%, P=.038 Lighter sedation- better outcome Brook. Crit Care Med 1999: 27: 2609-15  Lighter Level of Sedation 128 adults continuous infusion sedation drugs Daily wake-up versus standard care Daily wake-up shortened duration ventilation: 4.9 vS 7.3 days, p=0.004 median ICU LOS: 6.4 vs 9.9 d, p=0.02 diagnostic testing: 9% vS 27%, p=0.02 days patients were awake while receiving a sedative infusion 86% Vs 9%.p0. 001 Lighter sedation better outco