急诊科与重症监护室插管患者的镇静措施对比。

Jariya Sereeyotin, Christopher Yarnell, Sangeeta Mehta
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引用次数: 0

摘要

目的 本研究旨在比较急诊科(ED)与重症监护室(ICU)插管期间和插管后的镇静管理。方法 这是一项单中心回顾性队列研究,研究对象为 2018 年 1 月至 2022 年 2 月期间在急诊科或重症监护室插管并接受机械通气的成人。我们从电子病历中收集数据。主要结果是从插管到首次记录轻度镇静的持续时间,轻度镇静的定义是镇静激惹量表(SAS)评分为 3-4 分。关于插管使用的麻醉剂,氯胺酮是急诊室最常用的药物,使用频率高于重症监护室(61% 对 40%,P=0.001)。丙泊酚是重症监护室最常用的镇静剂,使用率高于急诊室(50% 对 33%,P=0.01)。此外,重症监护室使用苯二氮卓和芬太尼的频率更高(分别为 39% vs 6%,p<0.001 和 68% vs 9.5%,p<0.001)。插管后 24 小时内,68%(65/95)急诊科患者和 82%(138/169)重症监护室插管患者达到轻度镇静,中位持续时间分别为 13.5 小时和 10.5 小时。结论与在重症监护室插管的患者相比,在急诊室插管的重症患者可能需要更深的镇静和更长的时间才能达到轻度镇静。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sedation practices in patients intubated in the emergency department compared to the intensive care unit.
Purpose This study aimed to compare sedation management during and after intubation in the emergency department (ED) versus the intensive care unit (ICU). Methods This was a single-center retrospective cohort study of adults intubated in the ED or in the ICU and received mechanical ventilation between January 2018 and February 2022. We collected data from the electronic medical record. The primary outcome was duration from intubation to first documentation of light sedation, defined as a Sedation Agitation Scale score (SAS) of 3-4. Results The study included 264 patients, with 95 (36%) intubated in the ED and 169 (64%) in the ICU. Regarding anesthetic agents used for intubation, ketamine was the most commonly used drug in the ED and was used more frequently than in the ICU (61% vs 40%, p=0.001). Propofol was the predominant sedative used in the ICU, with a higher prevalence compared to the ED (50% vs 33%, p=0.01). Additionally, benzodiazepines and fentanyl were more frequently used in the ICU (39% vs 6%, p<0.001 and 68% vs 9.5%, p<0.001, respectively). Within 24 hours after intubation, 68% (65/95) ED patients and 82% (138/169) patients intubated in ICU achieved light sedation, with median durations of 13.5 hours and 10.5 hours. Patient location in the ED at intubation was associated with decreased probability of achieving light sedation at 24 hours (adjusted odds ratio 0.64, p=0.04). Conclusion Critically ill patients intubated in the ED are at risk of deeper sedation and a longer time to achieve light sedation compared to patients intubated in the ICU.
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