Comparison of two schemes of daily arousal and comfort analgesia and sedation in patients on mechanical ventilation in intensive care unit / 中华危重病急救医学

ABSTRACT

Objective To explore the efficacy of comfort analgesia and sedation in patients with mechanical ventilation in intensive care unit (ICU). Methods Eighty patients with mechanical ventilation admitted to ICU of Pingxiang People's Hospital from June 2017 to May 2018 were enrolled, and they were randomly divided into control group and observation group by random number table method, with 40 patients in each group. The control group was given a daily analgesic and sedation regimen with critical-care pain observation tool (CPOT) 0-3 and Richmond agitation-sedation scale (RASS) maintained at -3 to -4. The observation group was given comfort analgesic sedative scheme with immediate analgesia and sedation score, CPOT 0-1 and RASS -1-0. Under these circumstances, patients could be waken up at any time, feel comfortable and cooperate with treatment. The duration of mechanical ventilation, the length of ICU stay, ventilator associated pneumonia (VAP) rate, delirium rate and sedatives drugs usage were compared between the two groups. Results There were no significant differences in baseline data such as gender [male (cases) 25 vs. 28], age (years old 55.2±8.3 vs. 56.1±7.9), acute physiology and chronic health evaluationⅡ (APACHEⅡ 19.4±3.0 vs. 19.8±3.2) and etiology [sepsis (cases) 13 vs. 16, chronic obstructive pulmonary disease (cases) 12 vs. 10, acute lung injury (cases) 8 vs. 9, hemorrhagic shock (cases) 5 vs. 4, cardiogenic shock (cases) 2 vs. 1] between the observation group and the control group (all P > 0.05). Compared with control group, the duration of mechanical ventilation and the length of ICU stay were significantly decreased in observation group (days 5.6±1.9 vs. 7.8±2.7, 6.6±2.1 vs. 9.8±2.5, both P <0.01), the VAP rate and delirium rate were significantly decreased (17.5% vs. 40.0%, 25.0% vs. 47.5%, both P < 0.05), the average dose and total dose of sedative drugs were significantly reduced [propofol average dose (mg) 200.3±94.2 vs. 455.7±143.1, propofol total dose (mg) 1 266.4±419.7 vs. 2 682.6±734.1; dexmedetomidine average dose ( μg)726.6±241.1 vs. 1 312.7±841.6, dexmedetomidine total dose ( μg) 5 647.3±2 215.2 vs. 9 864.5±4 268.0; all P < 0.01]. Conclusion The therapy of comfort analgesia and sedatives on ICU patients with mechanical ventilation, can decrease the treatment time, lower the risk of adverse events, and reduce the dosage of sedatives drugs.