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Title: [Clinical application and evaluation of an early non-sedation protocol for critically ill respiratory patients].
Author: Huang JB, Lan CQ, Li HY, Chen L, Pan JG, Chen LL, Weng H, Zeng YM.
Journal: Zhonghua Jie He He Hu Xi Za Zhi; 2017 Mar 12; 40(3):188-192. PubMed ID: 28297813.
Abstract:
Objective: To study the value of an early (mechanical ventilation after 24 h) non-sedation protocol for intubated, mechanically ventilated patients in the respiratory intensive care unit (RICU). Methods: Seventy intubated, mechanically ventilated patients were prospectively enrolled and randomly assigned to management with early non-sedation (intervention group; n=35) or with daily interruption of sedation (DIS) (control group; n=35). The duration of mechanical ventilation, length of the RICU and hospital stay, RICU and hospital mortality, drug consumption, RICU and hospitalization expenses, incidence of complications and adverse events and serum levels of vital organ damage and inflammatory markers after mechanical ventilation for 48 h were recorded and compared. Results: Patients in the intervention group had a shorter duration of mechanical ventilation than those in the control group [(7±5) vs (11±9) d, P<0.05] and were discharged from the RICU [(9±7) vs (18±9) d, P<0.05] and hospital earlier [(17±14) vs (29±22) d, P<0.05] than those in the control group. The doses of midazolam were significantly lower in the intervention group than in the control group [(99±104) vs (482±337) mg, P<0.05]. The RICU and hospitalization expenses were both significantly lower in the intervention group than in the control group [53(84) vs 88(173), 72(195) vs 154(234) thousand CHY, P<0.05]. In the intervention group, the occurrence rates of ventilator associated pneumonia (23% vs 46%), tracheotomy (14% vs 37%) and gastrointestinal adverse reactions (17% vs 40%) were significantly lower than those in the control group (P<0.05). No differences were recorded in RICU and hospital mortality (P>0.05). The occurrence rates of unplanned extubation and reintubation and the need for CT brain scans were similar in the 2 groups (P>0.05). The levels of cardiac, liver and renal damage markers, lactic acid and C-reactive protein were the same in both groups (P>0.05). Conclusions: The early non-sedation protocol decreased the duration of mechanical ventilation and the length of stay in the RICU and hospital, and it did not increase the incidence of complications and adverse events. 目的： 探讨早期无镇静方案在呼吸重症监护病房(RICU)气管插管机械通气患者中的应用价值。 方法： 采用前瞻性随机对照研究，将2013年8月至2016年1月入住福州肺科医院RICU的70例机械通气患者按照随机数字表法分为两组：观察组35例，实施早期无镇静方案；对照组35例，实施每日中断镇静方案。比较两组的机械通气时间、住RICU时间和总住院时间、RICU病死率和医院内病死率、镇静剂和镇痛剂用量、医疗费用、各种并发症和不良事件发生率，并对比两组机械通气48 h重要器官损害指标及炎症指标。 结果： 观察组机械通气时间[(7±5)d]、住RICU时间[(9±7)d]、总住院时间[(17±14)d]、咪达唑仑人均剂量[(99±104)mg]、医疗费用[住RICU费用5.3(8.4)元和总住院费用7.2(19.5)元]、呼吸机相关性肺炎发生率(23%，8/35)、气管切开率(14%，5/35)和消化道不良反应发生率(17%，5/35)均低于对照组[机械通气时间(11±9)d、住RICU时间(18±9)d、总住院时间(29±22)d、咪达唑仑人均剂量(482±337)mg、住RICU费用8.8(17.3)万元、总住院费用15.4(23.4)万元、呼吸机相关性肺炎发生率46%(16/35)、气管切开率37%(13/35)、消化道不良反应发生率40%(14/35)]，差异有统计学意义(均P<0.05)。两组RICU病死率、医院内病死率、非计划拔管等不良事件比较差异均无统计学意义(均P>0.05)。两组机械通气48 h心、肝、肾功能损害指标及乳酸、CRP水平比较差异均无统计学意义(均P>0.05)。 结论： 早期无镇静策略可以缩短RICU患者机械通气时间、RICU停留时间和总住院时间，且未增加各种并发症及不良事件的发生风险。.

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