Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation
Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation
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DOI：
10.1097/00003246-199912000-00001
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发表时间：
1999-12-01
影响因子：
8.8
通讯作者：
Kollef, MH
中科院分区：
文献类型：
--
作者：
Brook, AD;Ahrens, TS;Kollef, MH
目的：比较护士在机械通气期间实施的协议指导的镇静与传统的非协议指导的镇静administration. Design的做法：随机，对照临床试验。患者被随机分配接受方案指导的镇静（n = 162）或非方案指导的镇静（n = 159）。机械通气的中位持续时间为55.9小时（95%置信区间，41.0-90.0小时），接受方案指导的镇静治疗的患者和117.0小时（95%置信区间，96.0-155.6小时）对于接受非方案指导镇静的患者。Kaplan-Meier分析表明，方案指导镇静组患者的机械通气持续时间在统计学上短于非方案指导镇静组患者（卡方= 7.00，p = .008，对数秩检验;卡方= 8.54，p = .004，Wilcoxon检验;卡方= 9.18，p = .003，-2对数检验）。方案指导镇静组患者在重症监护室（5.7 +/- 5.9天vs 7.5 +/- 6.5天; p = 0.013）和住院时间（14.0 +/- 17.3天vs 19.9 +/- 24.2天; p <0.001）也明显缩短。在接受持续静脉镇静的132例患者（41.1%）中，方案指导镇静组（n = 66）的持续静脉镇静持续时间显著短于非方案指导镇静组（n = 66）（3.5 ± 4.0天vs 5.6 ± 6.4天; p = 0.003）。与非协议指导镇静组患者相比，协议指导镇静组患者的气管切开率也明显较低（162例患者中的10例[6.2%] vs 159例患者中的21例[13.2%]，p = 0.038）。使用协议指导的镇静可以减少机械通气的持续时间，重症监护室和住院时间，对急性呼吸衰竭的危重病人应行气管切开术。
Objective: To compare a practice of protocol-directed sedation during mechanical ventilation implemented by nurses with traditional non-protocol-directed sedation administration.Design: Randomized, controlled clinical trial.Setting: Medical intensive care unit (19 beds) in an urban teaching hospital.Patients: Patients requiring mechanical ventilation (n = 321).Interventions: Patients were randomly assigned to receive either protocol-directed sedation (n = 162) or non-protocol-directed sedation (n = 159).Measurements and Main Results: The median duration of mechanical ventilation was 55.9 hrs (95% confidence interval, 41.0-90.0 hrs) for patients managed with protocol-directed sedation and 117.0 hrs (95% confidence interval, 96.0-155.6 hrs) for patients receiving non-protocol-directed sedation. Kaplan-Meier analysis demonstrated that patients in the protocol-directed sedation group had statistically shorter durations of mechanical ventilation than patients in the non-protocol-directed sedation group (chi-square = 7.00, p = .008, log rank test; chi-square = 8.54, p = .004, Wilcoxon's test; chi-square = 9.18, p = .003, -2 log test). Lengths of stay in the intensive care unit (5.7 +/- 5.9 days vs, 7.5 +/- 6.5 days; p = .013) and hospital (14.0 +/- 17.3 days vs. 19.9 +/- 24.2 days; p < .001) were also significantly shorter among patients in the protocol-directed sedation group. Among the 132 patients (41.1%) receiving continuous intravenous sedation, those in the protocol-directed sedation group (n = 66) had a significantly shorter duration of continuous intravenous sedation than those in the non-protocol-directed sedation group (n = 66) (3.5 +/- 4.0 days vs, 5.6 +/- 6.4 days; p = .003). Patients in the protocol-directed sedation group also had a significantly lower tracheostomy rate compared with patients in the non-protocol-directed sedation group (10 of 162 patients [6.2%] vs, 21 of 159 patients [13.2%], p = .038).Conclusions: The use of protocol-directed sedation can reduce the duration of mechanical ventilation, the intensive care unit and hospital lengths of stay, and the need far tracheostomy among critically ill patients with acute respiratory failure.