Reducing Sedative Exposure in Ventilated ICU Patients

机械通气是重症监护病房中最常用的高级生命支持方式 （ICU）治疗各种原因引起的呼吸功能不全。减少焦虑，压力和促进 由于机械通气的耐受性，护士经常给这些患者使用镇静剂。 镇静是指有时，它不是没有严重的副作用，其中包括肌肉无力，精神 状态变化、延长的辅助支持和延长的ICU住院时间。临床实践指南建议 在使用镇静剂之前，尝试非药物策略来减轻患者的痛苦。 然而，非药物策略未得到充分利用，并且在临床试验中缺乏严格的评估， 记录患者受益。一种非药物干预显示出减少焦虑的希望， 音乐是一种单一的治疗方法，但缺乏对临床显著结果的严格评估。因此，主要 这项临床试验的目的是测试一种以患者为导向的音乐干预（PDM）， 暴露和焦虑的成年通气患者，并检查伴随的影响， 治疗支持、ICU住院时间和压力调节。186例接受急性 将从中西部城市的5个ICU招募说明性支持者，用于这3组实验设计 反复研究。接受辅助支持的受试者将随机分配至PDM、噪声- 取消耳机，或通常照顾长达30天。镇静剂暴露（总剂量和剂量 频率）、焦虑水平（视觉模拟量表和状态焦虑量表）和24小时尿皮质醇 将每天采集所有样本（压力）。主要数据分析将采用重复测量ANCOVA， 控制疾病的严重程度。这项研究的长期目标是积极影响重要的临床 每年数百万接受机械通气的ICU患者的结局和生活质量 通过加强个人控制，同时减少接触镇静剂及其严重副作用。

Mechanical ventilation is the most frequently used advanced, life-supportive modality in intensive care units (ICUs) to treat respiratory insufficiency from a variety of causes. To reduce anxiety, stress and promote tolerance of mechanical ventilation, nurses frequently administer sedative agents to these patients.While sedation is indicated at times, it is not without serious side effects which include muscle weakness, mental status changes, prolonged ventilatory support, and extended ICU stay. Clinical practice guidelines suggest that non-pharmacologic strategies be tried to reduce patient distress before administering sedatives. However, non-pharmacologic strategies are under-utilized and lack rigorous evaluation in clinical trials that document patient benefit. One non-pharmacologic intervention that shows promise in reducing anxiety after a single treatment but lacks rigorous evaluation on clinically salient outcomes is music. Thus, the primary aim of this clinical trial is to test a patient-directed, as desired music intervention (PDM) on reducing sedative exposure and anxiety in adult ventilated patients, and to examine attendant influences on length of ventilatory support, length of ICU stay, and stress modulation. A sample of 186 alert patients receiving acute ventilatory support will be recruited from 5 ICUs in the urban Midwest for this 3 group experimental design study with repeated measures. Subjects receiving ventilatory support will be randomized to PDM, noise- canceling headphones, or to usual care for up to 30 days. Sedative exposure (aggregate dose and dose frequency), anxiety levels (visual analog scale and State Anxiety Inventory), and 24-hour urinary cortisol samples (stress) will all be collected daily. Primary data analysis will be repeated measuresANCOVA, controlling for illness severity. Long-term objectives of this study are to positively impact important clinical outcomes and quality of life for the millions of ICU patients who experience mechanical ventilation eachyear by enhancing personal control while reducing exposure to sedative agents and their serious sideeffects.