Analgesia and sedation strategy for mechanically ventilated patients in the respiratory ICU

IF 0.2 Q4 RESPIRATORY SYSTEM
Dalia Abd El Sattar El Embaby, Mai Azab, H. Shalaby
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引用次数: 0

Abstract

Background Mechanical ventilation is typically required for ICU patients as part of their care. This recommends the use of analgesia and sedation in a balanced strategy to alter patients’ comfort and assist synchronization with mechanical ventilation while avoiding the downsides of excessive sedation. Objective The aim of the study was to compare between deep sedation and light sedation, analgesia, and no sedation strategies and their effects on the length of mechanical ventilation, and their effects on patients’ prognosis. Patients and methods This cohort prospective pilot study was conducted at the medical respiratory ICU at Ain Shams University Hospital in Cairo, Egypt, on 54 patients separated into four groups according to the type of sedation and analgesia suited for each patient’s severity condition. Results In this study, 54 mechanically ventilated patients in respiratory ICU were recruited. The patients were divided into group 1: no sedation or analgesia, group 2: analgesia only, group 3: light sedation, and group 4: deep sedation. There was a significant difference in Acute Physiology and Chronic Health Evaluation score and severity%, although the Acute Physiology and Chronic Health Evaluation score and severity % were the highest in group 1 (25.53, 55.11%) and group 4 (23.40, 47.68%), but the prognosis was poorer in group 4 and was affected by deep sedation (100% death rate) than that in group 1 (60.0%). The average infusion rate of fentanyl and the total dose were significantly different between groups, the highest being in the deep sedation group. ICU length of stay was nonsignificant between groups but it was lower in group 4 (median: 9 days) than other groups. The average rate of dormicum infusion in the deep sedation group was 5 µg, while there was no daily vacation period; so, it can be explained that higher doses of sedation and analgesia in group 4 affected their prognosis to be poorer than other groups. Delirium occurred in 80% of group 4 patients, but only in 6.7% of subgroups, indicating a highly significant difference. Complications either metabolic, cardiac, or hematologic in the postextubation period were higher in group 4 (60%), than in group 1 (47.7%), group 2 (40%), and group 3 (15%). Conclusion Light sedation and analgesia strategies with daily sedation interruption would have a better survival outcome and cause fewer issues in patients, who were on mechanical ventilation than a heavy sedation approach.
呼吸科ICU机械通气患者的镇痛镇静策略
作为ICU患者护理的一部分,通常需要机械通气。这建议在平衡策略中使用镇痛和镇静,以改变患者的舒适度,并协助与机械通气同步,同时避免过度镇静的不利影响。目的比较深度镇静与轻度镇静、镇痛与不镇静策略对机械通气时间长短的影响,以及对患者预后的影响。患者和方法本队列前瞻性先导研究在埃及开罗Ain Shams大学医院内科呼吸ICU进行,54例患者根据患者病情严重程度的镇静镇痛类型分为四组。结果本研究共纳入呼吸道ICU机械通气患者54例。患者分为不镇静或不镇痛组1、仅镇痛组2、轻度镇静组3、深度镇静组4。两组患者急性生理和慢性健康评价评分及严重程度%差异有统计学意义,虽然1组患者急性生理和慢性健康评价评分及严重程度%最高(25.53,55.11%),4组患者最高(23.40,47.68%),但4组患者预后较1组差,且受深度镇静影响(死亡率100%),较1组(60.0%)有显著性差异。芬太尼平均输注速率和总剂量组间差异有统计学意义,以深度镇静组最高。ICU住院时间组间差异无统计学意义,但第4组(中位数:9天)低于其他组。深度镇静组平均睡眠输注量为5µg,每日无休假时间;因此,可以解释为第4组镇静镇痛剂量越大,其预后较其他组差。4组患者谵妄发生率为80%,但亚组仅为6.7%,差异极显著。拔管后的代谢、心脏或血液学并发症在4组(60%)高于1组(47.7%)、2组(40%)和3组(15%)。结论轻度镇静和镇痛策略与每日镇静中断相比,机械通气患者的生存结果更好,引起的问题更少。
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来源期刊
自引率
0.00%
发文量
46
审稿时长
22 weeks
期刊介绍: The journal will cover technical and clinical studies related to health, ethical and social issues in field of The Egyptian Journal of Chest Diseases and Tuberculosis aims to publish and inform readers and all chest physicians of the progress in medical research concerning all aspect of chest diseases. Publications include original articles review articles, editorials, case studies and reports which are relevant to chest diseases. The Journal also aims to highlight recent updates in chest medicine. . Articles with clinical interest and implications will be given preference.
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