A prospective randomised pilot study of sedation regimens in a general ICU population: a reality-based medicine study
A prospective randomised pilot study of sedation regimens in a general ICU population: a reality-based medicine study
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DOI：
10.1186/cc344
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发表时间：
1999-01-01
期刊：
影响因子：
15.1
通讯作者：
Fisher, MM
中科院分区：
文献类型：
--
作者：
Finfer, SR;O'Connor, AM;Fisher, MM
背景资料：出于后勤原因，镇静研究通常在择期手术患者中进行，并将结果外推至一般重症监护室（ICU）人群。我们质疑这种做法的有效性。我们比较了两种镇静方案在我们的普通ICU在一项试验中使用的结构，以模仿临床实践，尽可能接近。结果：40例患者被随机分配到间歇地西泮或连续咪达唑仑和镇静监测每小时镇静评分; 31例患者完成了研究。镇静不足评分在地西泮组更常见（P< 0.01）;总体镇静充分率咪达唑仑组为64.7%，地西泮组为35.7%（P= 0.21）。没有患者表现出不适当的镇静延长。成本是：结论：两种方案均产生可接受的镇静作用，但镇静不足似乎更常见于较便宜的地西泮方案。至少应研究140例患者，以提供适用于一般ICU人群的证据。单独使用时，镇静评分可能不是镇静试验的适当结局指标。
Background: For logistical reasons sedation studies are often carried out in elective surgical patients and the results extrapolated to the general intensive care unit (ICU) population. We question the validity of this approach. We compared the two sedation regimens used in our general ICU in a trial structured to mimic clinical practice as closely as possible.Results: Forty patients were randomised to intermittent diazepam or continuous midazolam and sedation monitored with hourly sedation scores; 31 patients completed the study. Scores indicating undersedation were more common with diazepam (P< 0.01); overall adequate sedation midazolam 64.7%, diazepam 35.7% (P= 0.21). No patient exhibited inappropriately prolonged sedation. Cost was: midazolam AUS $1.98/h; diazepam AUS $0.06/h.Conclusion: Both regimens produced rapid onset of acceptable sedation but undersedation appeared more common with the cheaper diazepam regimen. At least 140 patients should be studied to provide evidence applicable to the general ICU population. Used alone, a sedation score may be an inappropriate outcome measure for a sedation trial.