Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
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神经重症监护病房中规范镇痛和镇静的结果。
DOI：
10.1080/02699052.2018.1469167
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发表时间：
2018
期刊：
影响因子：
1.9
通讯作者：
Wendell,LindaC
中科院分区：
文献类型：
--
作者：
Mahmoud,Leana;Zullo,AndrewR;Thompson,BradfordB;Wendell,LindaC
目的：在神经重症监护室（NCCU）中，提供镇痛和镇静同时允许进行神经评估是重要的，但有关协议镇痛和镇静效果的数据有限。我们开发了一个基于镇静协议，并评估其对药物利用率和成本的影响在NCCU.Methods：我们进行了一项回顾性队列研究的患者谁是机械通气，并承认12床NCCU超过四年。为了比较结果，我们使用伽马和负二项回归模型，并中断时间序列的敏感性analysis.Results：研究队列包括1197例患者：576前协议和621后协议。该方案导致芬太尼使用量增加[发生率比（IRR）= 2.8，（95%置信限（CL）1.9，4.2）]，异丙酚使用量减少（IRR = 0.8，CL 0.6，1.0）。芬太尼（成本比= 0.8，CLs 0.5，1.1）和丙泊酚成本（成本比= 0.6，CLs 0.5，0.8）降低。敏感性分析结果相似。有没有影响医疗保健利用率，医疗费用，和住院mortality.Conclusion：议定镇痛和镇静增加镇痛使用，减少镇静剂的使用，并减少药物相关的费用在NCCU。我们的研究结果表明，类似的NCCU应考虑使用特定人群的协议来管理镇痛和镇静。
Objectives: Providing analgesia and sedation while allowing for neurological assessment is important in the neurocritical care unit (NCCU), yet data are limited about the effects of protocolised analgesia and sedation. We developed an analgesia-based sedation protocol and evaluated its effect on medication utilisation and costs in the NCCU.Methods: We conducted a retrospective cohort study of patients who are mechanically ventilated and admitted to a 12-bed NCCU over four years. To compare outcomes, we used gamma and negative binomial regression models, and interrupted time-series sensitivity analyses.Results: The study cohort consisted of 1197 patients: 576 pre-protocol and 621 post-protocol. The protocol resulted in an increase in fentanyl use [incidence rate ratio (IRR) = 2.8, (95% confidence limits (CLs) 1.9, 4.2)] and a decrease in propofol use (IRR = 0.8, CLs 0.6, 1.0). There was a decrease in fentanyl (cost ratio = 0.8, CLs 0.5, 1.1) and propofol costs (cost ratio = 0.6, CLs 0.5, 0.8). The sensitivity analyses results were similar. There was no effect on healthcare utilisation, healthcare costs, and in-hospital mortality.Conclusion: Protocolised analgesia and sedation increased analgesia use, decreased sedative use, and reduced medication-associated costs in the NCCU. Our results suggest that similar NCCUs should consider use of population-specific protocols to manage analgesia and sedation.