A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients
A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients
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DOI：
10.1097/01.ccm.0000215513.63207.7f
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发表时间：
2006-05-01
影响因子：
8.8
通讯作者：
Hall, J
中科院分区：
文献类型：
--
作者：
Carson, SS;Kress, JP;Hall, J
目的：比较随机接受劳拉西泮间歇推注与连续输注异丙酚使用协议，包括预定的每日中断sedation.Design：一个随机开放标签试验，从2001年10月至2004年3月招募患者的机械通气的持续时间。两个三级医疗中心的重症监护室。预计需要机械通气>48小时且需要>= 10 mg劳拉西泮或持续输注镇静剂以达到充分镇静的成人患者。患者随机接受劳拉西泮间歇推注给药或丙泊酚持续输注，以维持Ramsay评分2-3。两组每天都中断镇静。测量和主要结果：主要结果是中位呼吸机天数。次要结局包括28天无呼吸机生存率、重症监护室和住院时间以及住院死亡率。与间歇性推注劳拉西泮组相比，每日中断丙泊酚组的中位呼吸机天数显著较低（5.8 vs. 8.4，p = 0.04）。住院幸存者的差异最大（4.4 vs. 9.0，p = 0.006）。每日中断丙泊酚组患者的无呼吸机生存率有更高的趋势（丙泊酚组的中位数为18.5天，劳拉西泮组为10.2天，p = 0.06）。结论：对于需要>48小时机械通气的内科患者，与间歇性劳拉西泮相比，每天中断镇静剂时，丙泊酚镇静导致呼吸机天数显著减少。
Objective: To compare duration of mechanical ventilation for patients randomized to receive lorazepam by intermittent bolus administration vs. continuous infusions of propofol using protocols that include scheduled daily interruption of sedation.Design: A randomized open-label trial enrolling patients from October 2001 to March 2004.Setting. Medical intensive care units of two tertiary care medical centers.Patients. Adult patients expected to require mechanical ventilation for >48 hrs and who required >= 10 mg of lorazepam or a continuous infusion of a sedative to achieve adequate sedation.Interventions. Patients were randomized to receive lorazepam by intermittent bolus administration or propofol by continuous infusion to maintain a Ramsay score of 2-3. Sedation was interrupted on a daily basis for both groups.Measurements and Main Results: The primary outcome was median ventilator days. Secondary outcomes included 28-day ventilator-free survival, intensive care unit and hospital length of stay, and hospital mortality. Median ventilator days were significantly lower in the daily interruption propofol group compared with the intermittent bolus lorazepam group (5.8 vs. 8.4, p =.04). The difference was largest for hospital survivors (4.4 vs. 9.0, p =.006). There was a trend toward greater ventilator-free survival for patients in the daily interruption propofol group (median 18.5 days for propofol vs. 10.2 for lorazepam, p =.06). Hospital mortality was not different.Conclusions: For medical patients requiring >48 hrs of mechanical ventilation, sedation with propofol results in significantly fewer ventilator days compared with intermittent lorazepam when sedatives are interrupted daily.