The AIR-SED Study: A Multicenter Cohort Study of SEDation Practices, Deep Sedation, and Coma Among Mechanically Ventilated AIR Transport Patients.
The AIR-SED Study: A Multicenter Cohort Study of SEDation Practices, Deep Sedation, and Coma Among Mechanically Ventilated AIR Transport Patients.
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DOI：
10.1097/cce.0000000000000597
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发表时间：
2021-12
影响因子：
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通讯作者：
Fuller BM
中科院分区：
文献类型：
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作者：
Moy HP;Olvera D;Nayman BD;Pappal RD;Hayes JM;Mohr NM;Kollef MH;Palmer CM;Ablordeppey E;Faine B;Roberts BW;Fuller BM
文本中提供了补充数字内容。描述院前空中医疗运输镇静实践的特征，并检验与镇痛和镇静的监测和输送相关的可修改变量与院前深度镇静相关的假设。多中心、回顾性队列研究。一家全国性的多中心（约130个基地）空中医疗运输提供商。在院前环境中接受治疗的连续性成人机械通气空中医疗转运患者（2015年1月至2020年12月）。没有。记录所有涉及镇静的数据（药物、监测）。深度镇静定义为：1）里士满躁动-镇静量表为-3至-5; 2）拉姆齐镇静量表为5或6;或3）格拉斯哥昏迷量表小于或等于9。昏迷定义为无反应，并基于中位镇静深度：1）里士满躁动-镇静量表-5; 2）Ramsay量表6;或3）格拉斯哥昏迷量表3。共有72，148名患者接受了研究。院前深度镇静63,478例（88.0%），昏迷42,483例（58.9%）。深度镇静的患者更频繁地接受神经肌肉阻滞剂治疗，并且不太可能用经验证的镇静深度量表记录镇静深度（即，Ramsay或里士满激动-镇静量表）。调整协变量后，多变量逻辑回归模型表明，使用长效神经肌肉阻滞剂（即，罗库溴铵和维库溴铵）是深度镇静的独立预测因子（校正比值比，1.28; 95%CI，1.22-1.35; p < 0.001），而使用经验证的镇静量表与深度镇静的较低比值相关（校正比值比，0.29; 95%CI，0.27-0.30; p < 0.001）。深度镇静（和昏迷）在机械通气空气转运患者中非常常见，并且与镇痛和镇静的监测和递送相关的可变变量相关。院前竞技场的镇静实践和相关的临床结果需要进一步调查。
Supplemental Digital Content is available in the text. To characterize prehospital air medical transport sedation practices and test the hypothesis that modifiable variables related to the monitoring and delivery of analgesia and sedation are associated with prehospital deep sedation. Multicenter, retrospective cohort study. A nationwide, multicenter (approximately 130 bases) air medical transport provider. Consecutive, adult mechanically ventilated air medical transport patients treated in the prehospital environment (January 2015 to December 2020). None. All data involving sedation (medications, monitoring) were recorded. Deep sedation was defined as: 1) Richmond Agitation-Sedation Scale of –3 to –5; 2) Ramsay Sedation Scale of 5 or 6; or 3) Glasgow Coma Scale of less than or equal to 9. Coma was defined as being unresponsive and based on median sedation depth: 1) Richmond Agitation-Sedation Scale of –5; 2) Ramsay of 6; or 3) Glasgow Coma Scale of 3. A total of 72,148 patients were studied. Prehospital deep sedation was observed in 63,478 patients (88.0%), and coma occurred in 42,483 patients (58.9%). Deeply sedated patients received neuromuscular blockers more frequently and were less likely to have sedation depth documented with a validated sedation depth scale (i.e., Ramsay or Richmond Agitation-Sedation Scale). After adjusting for covariates, a multivariable logistic regression model demonstrated that the use of longer-acting neuromuscular blockers (i.e., rocuronium and vecuronium) was an independent predictor of deep sedation (adjusted odds ratio, 1.28; 95% CI, 1.22–1.35; p < 0.001), while use of a validated sedation scale was associated with a lower odds of deep sedation (adjusted odds ratio, 0.29; 95% CI, 0.27–0.30; p < 0.001). Deep sedation (and coma) is very common in mechanically ventilated air transport patients and associated with modifiable variables related to the monitoring and delivery of analgesia and sedation. Sedation practices in the prehospital arena and associated clinical outcomes are in need of further investigation.