tailieunhanh - Báo cáo y học: " Pushing the envelope to reduce sedation in critically ill patients"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Pushing the envelope to reduce sedation in critically ill patients. | Ogundele and Yende Critical Care 2010 14 339 http content 14 6 339 CRITICAL CARE JOURNAL CLUB CRITIQUE L Pushing the envelope to reduce sedation in critically ill patients Olufunmilayo Ogundele and Sachin Yende Expanded Abstract Citation Strom T Martinussen T Toft P A protocol of no sedation for critically ill patients receiving mechanical ventilation a randomized trial. Lancet 2010 375 475-480 1 . Background Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. Daily interruption of sedation has a beneficial effect and in the general intensive care unit of Odense University Hospital Denmark standard practice is a protocol of no sedation. We aimed to establish whether duration of mechanical ventilation could be reduced with a protocol of no sedation versus daily interruption of sedation. Methods Of 428 patients assessed for eligibility we enrolled 140 critically ill adult patients who were undergoing mechanical ventilation and were expected to need ventilation for more than 24 h. Patients were randomly assigned in a 1 1 ratio unblinded to receive no sedation n 70 patients or sedation 20 mg mL propofol for 48 h 1 mg mL midazolam thereafter with daily interruption until awake n 70 control group . Both groups were treated with bolus doses of morphine or 5 mg . The primary outcome was the number of days without mechanical ventilation in a 28-day period and we also recorded the length of stay in the intensive care unit from admission to 28 days and in hospital from admission to 90 days . Analysis was by intention to treat. This study is registered with number NCT00466492. Findings 27 patients died or were successfully extubated within 48 h and as per our study design were excluded from Correspondence yendes@ University of Pittsburgh Medical Center Department of Critical Care Medicine 606D Scaife Hall 3550 Terrace Street University of Pittsburgh Pittsburgh