Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: a randomised trial [ISRCTN47583497].
Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: a randomised trial [ISRCTN47583497].
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DOI：
10.1186/cc3495
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发表时间：
2005-06
期刊：
影响因子：
15.1
通讯作者：
Kirkham, AJ
中科院分区：
文献类型：
--
作者：
Breen, D;Karabinis, A;Malbrain, M;Morais, R;Albrecht, S;Jarnvig, IL;Parkinson, P;Kirkham, AJ
这项随机、开放标签、多中心研究比较了瑞芬太尼镇静方案与传统催眠镇静方案在需要长时间机械通气长达10天的危重患者中的安全性和有效性。105例随机化患者接受瑞芬太尼为基础的镇静方案（初始剂量6至9 μg kg-1 h-1（0.1至0.15 μg kg-1 min-1），在添加咪达唑仑进行进一步镇静之前滴定至反应（n = 57），或添加芬太尼或吗啡进行镇痛的咪达唑仑为基础的镇静方案（n = 48）。患者镇静至最佳镇静-躁动量表（SAS）评分为3或4，疼痛强度（PI）评分为1或2。瑞芬太尼为基础的镇静方案显著减少了机械通气时间超过2天（53.5小时，P = 0.033），并显著减少了从脱机过程开始到拔管的时间超过1天（26.6小时，P < 0.001）。重症监护室（ICU）的住院时间有缩短1天的趋势。两组最佳SAS和PI的中位时间相同。在10天未拔管的患者中，停用研究药物时，药效学效应抵消的中位时间存在显著差异（瑞芬太尼0.250小时，对照药物1.167小时; P < 0.001）。在接受瑞芬太尼治疗的患者中，26%的患者在研究期间没有接受任何咪达唑仑。在那些接受咪达唑仑的患者中，使用瑞芬太尼大大减少了所需咪达唑仑的总剂量。在第3天和第10天之间，雷米芬太尼的加权平均输注速率保持恒定，没有证据表明雷米芬太尼的累积或耐受性的发展。在停用研究药物后24小时内，两组之间的SAS或PI评分无差异。瑞芬太尼耐受性良好。瑞芬太尼镇痛镇静的耐受性良好;与标准催眠镇静方案相比，对于需要长期通气长达10天的ICU患者，它缩短了机械通气的持续时间，并改善了脱机过程。
This randomised, open-label, multicentre study compared the safety and efficacy of an analgesia-based sedation regime using remifentanil with a conventional hypnotic-based sedation regime in critically ill patients requiring prolonged mechanical ventilation for up to 10 days. One hundred and five randomised patients received either a remifentanil-based sedation regime (initial dose 6 to 9 μg kg-1 h-1 (0.1 to 0.15 μg kg-1 min-1) titrated to response before the addition of midazolam for further sedation (n = 57), or a midazolam-based sedation regime with fentanyl or morphine added for analgesia (n = 48). Patients were sedated to an optimal Sedation–Agitation Scale (SAS) score of 3 or 4 and a pain intensity (PI) score of 1 or 2. The remifentanil-based sedation regime significantly reduced the duration of mechanical ventilation by more than 2 days (53.5 hours, P = 0.033), and significantly reduced the time from the start of the weaning process to extubation by more than 1 day (26.6 hours, P < 0.001). There was a trend towards shortening the stay in the intensive care unit (ICU) by 1 day. The median time of optimal SAS and PI was the same in both groups. There was a significant difference in the median time to offset of pharmacodynamic effects when discontinuing study medication in patients not extubated at 10 days (remifentanil 0.250 hour, comparator 1.167 hours; P < 0.001). Of the patients treated with remifentanil, 26% did not receive any midazolam during the study. In those patients that did receive midazolam, the use of remifentanil considerably reduced the total dose of midazolam required. Between days 3 and 10 the weighted mean infusion rate of remifentanil remained constant with no evidence of accumulation or of a development of tolerance to remifentanil. There was no difference between the groups in SAS or PI score in the 24 hours after stopping the study medication. Remifentanil was well tolerated. Analgesia-based sedation with remifentanil was well tolerated; it reduces the duration of mechanical ventilation and improves the weaning process compared with standard hypnotic-based sedation regimes in ICU patients requiring long-term ventilation for up to 10 days.
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影响因子：
8.8
作者：
WESTMORELAND, CL;HOKE, JF;MUIR, KT
通讯作者：
MUIR, KT
影响因子：
8.8
作者：
Riker, RR;Picard, JT;Fraser, GL
通讯作者：
Fraser, GL
影响因子：
8.8
作者：
Dahaba, AA;Grabner, T;Metzler, H
通讯作者：
Metzler, H
影响因子：
10.7
作者：
Breslin, DS;Reid, JE;McBrien, ME
通讯作者：
McBrien, ME
影响因子：
8.8
作者：
KAPILA, A;GLASS, PSA;SMITH, RL
通讯作者：
SMITH, RL