以咪达唑仑为基础的镇静对外伤性脑损伤降压治疗需求的比较效果。

IF 1.8 Q3 CLINICAL NEUROLOGY
Neurotrauma reports Pub Date : 2025-03-05 eCollection Date: 2025-01-01 DOI:10.1089/neur.2024.0077
Rianne G F Dolmans, Giovanni Russo, James Anstey, Ewout W Steyerberg, Fabio S Taccone, Andrew Udy, Giuseppe Citerio, Carole Ichai, Rafael Badenes, John Prowle, Ari Ercole, Mauro Oddo, Antoine Schneider, Stefan Wolf, Raimund Helbok, David Nelson, D Jamie Cooper, Mathieu van der Jagt
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引用次数: 0

摘要

镇静药在重症监护病房(ICU)重症颅脑损伤(sTBI)患者的治疗中发挥着重要作用。苯二氮卓类药物通常用于镇静(以咪达唑仑为基础),但不建议用于ICU的非脑损伤患者。本研究旨在探讨咪达唑仑为基础的镇静与非咪达唑仑为基础的镇静对ICU sTBI患者降低颅内压(ICP)治疗需求的影响。我们研究了来自欧洲和澳大利亚14个ICU的sTBI (Glasgow Coma Sale≤8)患者,他们接受ICP监测和连续仪器变量(IV)镇静至少24小时。我们使用多变量logistic回归模型分析了镇静策略与前7个ICU天内降低ICP治疗需求之间的关系,并根据损伤严重程度的临床标记进行了调整。我们还分析了中心作为随机效应模型中的IV,以解决潜在的无法测量的混淆。在227例sTBI患者中,152例(67%)接受了咪达唑仑镇静。与非咪达唑仑镇静组的75名患者相比,这些患者入院时年龄更低,格拉斯哥昏迷评分中位数更高。在logistic回归分析中,使用咪达唑仑类镇静剂的患者接受高渗治疗的几率更高(优势比[OR]: 3.4, 95%可信区间[CI]: 1.6-7.7)。这一效应在工具变量分析(高渗治疗:OR: 1.3, 95% CI: 0.1-13.1)中无法得到证实。与非咪达唑仑镇静组相比,咪达唑仑镇静组的平均ICU住院时间明显更长(19天vs 13天,风险比0.6,95% CI: 0.4-0.8)。以咪达唑仑为基础的镇静在sTBI患者中很常见,对ICP治疗的需求没有显著增加,但与ICU住院时间延长有关。对于TBI危重患者的镇静策略,需要更大的前瞻性比较有效性研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparative Effectiveness of Midazolam-Based Sedation on the Need for Intracranial Pressure Lowering Therapies in Traumatic Brain Injury.

Sedatives play an important role in the management of patients with severe traumatic brain injury (sTBI) in the intensive care unit (ICU). Benzodiazepines are common for sedation (midazolam-based) but have been discouraged for non-brain-injured patients in the ICU. This study aimed to investigate the effect of midazolam-based sedation versus non-midazolam-based sedation on the need for intracranial pressure (ICP) lowering therapies in patients with sTBI in the ICU. We studied patients with sTBI (Glasgow Coma Sale ≤8) from 14 ICUs in Europe and Australia, who received ICP monitoring and continuous instrumental variable (IV) sedation for at least 24 h. We analyzed the association between sedation strategy and the need for ICP lowering therapies during the first 7 ICU days using a multivariable logistic regression model, adjusted for clinical markers of injury severity. We also analyzed the center as an IV in a random effects model to address potentially unmeasured confounding. Among 227 patients with sTBI, 152 (67%) received midazolam-based sedation. These patients had a lower age and higher median Glasgow Coma Scale on admission compared with 75 patients in the non-midazolam-sedated group. In logistic regression analyses, patients with midazolam-based sedation had higher odds of receiving hyperosmolar therapy (odds ratio [OR]: 3.4, 95% confidence intervals [CI]: 1.6-7.7). This effect could not be confirmed in the instrumental variable analysis (hyperosmolar therapy: OR: 1.3, 95% CI: 0.1-13.1). The mean ICU length of stay was significantly longer in the midazolam-based sedation group compared with the non-midazolam-based sedation group (19 vs. 13 days, hazards ratio 0.6, 95% CI: 0.4-0.8). Midazolam-based sedation was common for patients with sTBI without a significantly increased need for ICP therapies but an association with longer ICU stay. Larger prospective comparative effectiveness studies are needed regarding sedation strategies in critically ill patients with TBI.

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