Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation

被引:1790
作者
Kress, JP
Pohlman, AS
O'Connor, MF
Hall, JB
机构
[1] Univ Chicago, Dept Med, Sect Pulm & Crit Care, Chicago, IL 60637 USA
[2] Univ Chicago, Dept Anesthesia & Crit Care, Chicago, IL 60637 USA
关键词
D O I
10.1056/NEJM200005183422002
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Continuous infusions of sedative drugs in the intensive care unit may prolong the duration of mechanical ventilation, prolong the length of stay in the intensive care unit and the hospital, impede efforts to perform daily neurologic examinations, and increase the need for tests to assess alterations in mental status. Whether regular interruption of such infusions might accelerate recovery is not known. Methods: We conducted a randomized, controlled trial involving 128 adult patients who were receiving mechanical ventilation and continuous infusions of sedative drugs in a medical intensive care unit. In the intervention group, the sedative infusions were interrupted until the patients were awake, on a daily basis; in the control group, the infusions were interrupted only at the discretion of the clinicians in the intensive care unit. Results: The median duration of mechanical ventilation was 4.9 days in the intervention group, as compared with 7.3 days in the control group (P=0.004), and the median length of stay in the intensive care unit was 6.4 days as compared with 9.9 days, respectively (P=0.02). Six of the patients in the intervention group (9 percent) underwent diagnostic testing to assess changes in mental status, as compared with 16 of the patients in the control group (27 percent, P=0.02). Complications (e.g., removal of the endotracheal tube by the patient) occurred in three of the patients in the intervention group (4 percent) and four of the patients in the control group (7 percent, P=0.88). Conclusions: In patients who are receiving mechanical ventilation, daily interruption of sedative-drug infusions decreases the duration of mechanical ventilation and the length of stay in the intensive care unit. (N Engl J Med 2000;342:1471-7.) (C)2000, Massachusetts Medical Society.
引用
收藏
页码:1471 / 1477
页数:7
相关论文
共 29 条
  • [1] PERMISSIVE HYPERCAPNIA IN ACUTE RESPIRATORY-FAILURE
    BIDANI, A
    TZOUANAKIS, AE
    CARDENAS, VJ
    ZWISCHENBERGER, JB
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1994, 272 (12): : 957 - 962
  • [2] Unplanned extubations in the adult intensive care unit - A prospective multicenter study
    Boulain, T
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 157 (04) : 1131 - 1137
  • [3] COMPLICATIONS OF INTRAHOSPITAL TRANSPORT IN CRITICALLY ILL PATIENTS
    BRAMAN, SS
    DUNN, SM
    AMICO, CA
    MILLMAN, RP
    [J]. ANNALS OF INTERNAL MEDICINE, 1987, 107 (04) : 469 - 473
  • [4] PROPOFOL VS MIDAZOLAM IN SHORT-TERM, MEDIUM-TERM, AND LONG-TERM SEDATION OF CRITICALLY ILL PATIENTS - A COST-BENEFIT-ANALYSIS
    CARRASCO, G
    MOLINA, R
    COSTA, J
    SOLER, JM
    CABRE, L
    [J]. CHEST, 1993, 103 (02) : 557 - 564
  • [5] Comparative study of propofol versus midazolam in the sedation of critically ill patients: Results of a prospective, randomized, multicenter trial
    Chamorro, C
    deLatorre, FJ
    Montero, A
    SanchezIzquierdo, JA
    Jareno, A
    Moreno, JA
    Gonzalez, E
    Barrios, M
    Carpintero, JL
    MartinSantos, F
    Otero, B
    Ginestal, R
    [J]. CRITICAL CARE MEDICINE, 1996, 24 (06) : 932 - 939
  • [6] THE COST OF SEDATING AND PARALYZING THE CRITICALLY ILL PATIENT
    CHENG, EY
    [J]. CRITICAL CARE CLINICS, 1995, 11 (04) : 1005 - &
  • [7] Antifungal activity in grasses infected with Acremonium and Epichloe endophytes
    Christensen, MJ
    [J]. AUSTRALASIAN PLANT PATHOLOGY, 1996, 25 (03) : 186 - 191
  • [8] COX DR, 1972, J R STAT SOC B, V34, P187
  • [9] PERMISSIVE HYPERCAPNIA - HOW PERMISSIVE SHOULD WE BE
    FEIHL, F
    PERRET, C
    [J]. AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1994, 150 (06) : 1722 - 1737
  • [10] GUNDLACH CA, 1991, HOSP FORMUL, V26, P132