The incidence of sub-optimal sedation in the ICU: a systematic review.
The incidence of sub-optimal sedation in the ICU: a systematic review.
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DOI：
10.1186/cc8212
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Walsh TS
中科院分区：
文献类型：
--
作者：
Jackson DL;Proudfoot CW;Cann KF;Walsh TS
重症监护病房 (ICU) 中的患者通常需要长时间服用镇静剂。过度镇静和镇静不足都会对患者安全和资源利用产生负面影响。我们对文献进行了系统回顾，以确定 ICU 中镇静效果不佳（镇静过度和镇静不足）的发生率。我们检索了 1988 年至 2008 年 5 月 15 日期间的 Medline、Embase 和 CINAHL（护理和联合健康文献累积索引）在线文献数据库，并手工检索了会议。在 ICU 中进行的英语研究，对接受机械通气的成年人进行镇静，报告了次优镇静的发生率。所有摘要均由两名独立审稿人审阅两次，所有冲突均由第三位审稿人解决，以检查它们是否符合审稿纳入标准。检索所有纳入研究的全文，并根据纳入标准再次审查两次。数据被双重提取。提取了研究目的、设计、人群、比较以及次优、最佳、镇静过度或镇静不足发生率的数据。纳入的研究之间在最佳镇静的定义以及用于评估镇静的量表或方法方面存在相当大的差异。在所有纳入的研究中，报告称镇静效果不佳的发生率很高，并且过度镇静的趋势更大。我们的综述表明，镇静定义和测量的一致性的改进可能会提高 ICU 患者的护理质量。
Patients in intensive care units (ICUs) are generally sedated for prolonged periods. Over-sedation and under-sedation both have negative effects on patient safety and resource use. We conducted a systematic review of the literature in order to establish the incidence of sub-optimal sedation (both over- and under-sedation) in ICUs. We searched Medline, Embase and CINAHL (Cumulative Index to Nursing and Allied Health Literature) online literature databases from 1988 to 15 May 2008 and hand-searched conferences. English-language studies set in the ICU, in sedated adult humans on mechanical ventilation, which reported the incidence of sub-optimal sedation, were included. All abstracts were reviewed twice by two independent reviewers, with all conflicts resolved by a third reviewer, to check that they met the review inclusion criteria. Full papers of all included studies were retrieved and were again reviewed twice against inclusion criteria. Data were doubly extracted. Study aims, design, population, comparisons made, and data on the incidence of sub-optimal, optimal, over-sedation or under-sedation were extracted. There was considerable variation between included studies in the definition of optimal sedation and in the scale or method used to assess sedation. Across all included studies, a substantial incidence of sub-optimal sedation was reported, with a greater tendency toward over-sedation. Our review suggests that improvements in the consistent definition and measurement of sedation may improve the quality of care of patients within the ICU.
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