ObjectiveTo explore the applicability of early goal-directed sedation (EGDS) in intensive care unit (ICU) patients with mechanical ventilation.MethodsAn prospective double blind study was conducted. ICU patients with mechanical ventilation in the First Affiliated Hospital of Jinzhou Medical University were recruited as research objects by chester sampling from September 2015 to September 2017, and divided into an experimental group and a control group by stratified randomization. Two groups were sedated on the basis of adequate analgesia. The experimental group adopted the EGDS strategy that dexmedetomidin was the first choice to be infused at the rate of 1 μg·kg^–1·h^–1. And the patients were given Richmond agitation-sedation score (RASS) on the interval of 4 hours: used additionally propofol and midazolam if RASS>2, or reduced right metomomidin at the speed of 0.2 μg·kg^–1·h^–1 per 30 min if RASS<–3, and stopped sedation until RASS of –2 to 0. The control group adopted routine sedation strategy that propofol was the first choice to be infused and combined with dexmedetomidine and midazolam until RASS score in –2 to –3. The doses of sedative drugs, mechanical ventilation time, ICU-stayed time, total hospitalization time and the incidence of adverse events such as delirium, accidental extubation, and ICU death were compared between two groups.ResultsSixty-sis cases were selected in the experimental group and 71 in the control group. The baseline data such as gender, age, acute physiology chronic health evaluation Ⅱ (APACHEⅡ), or basic diseases in two groups had no significant differences. Compared with the control group, the per capita total doses of dexmedetomidine, propofol and midazolam in the experimental group were significantly less [right metopromicine (μg): 154.45±27.86 vs. 378.85±39.76; propofol (mg): 4 490.03±479.88 vs. 7 349.76±814.31; midazolam (mg): 255.38±46.24 vs. 562.79±97.26; all P<0.01], mechanical ventilation time, ICU-stayed time, total hospitalization time were significantly lower [mechanical ventilation time (d): 7.7±3.3vs. 11.7±3.6; ICU-stayed time (d): 10.2±3.9 vs. 19.2±4.1, total hospitalization time (d): 29.9±4.6 vs. 50.4±9.1; all P<0.01]. The Kaplan-Meier survival curves showed that the incidence of delirium in the experimental group was significantly lower than that in the control group (log-rankχ²=5.481, P<0.05). The accidental extubation rate and accidental fatality rate in two groups had no significant differences (log-rankχ²=0.078, 0.999, P>0.05).ConclusionEGDS can not only reduce the dose of sedative drugs, shorten the mechanical ventilation time, the ICU-stayed time and the total hospitalization time, but also reduce the incidence of delirium, so it has a positive impact in ICU patients with mechanical ventilation.

Citation： SUN Minghan, HAO Chunyan, DI Xingwei. Application of early goal-directed sedation in ICU patients with mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(6): 588-592. doi: 10.7507/1671-6205.201805023 Copy

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