事件记录
播音员: 健康信息来自预期，由研究支持. 来自犹他大学健康中心，大发娱乐是scoperadio.com.
面试官: Sedation is commonly used in the intensive care unit to make patients that require mechanical ventilation more comfortable 更少焦虑. What many don't realize is that sedation can have side effects that can endanger the patient's life. 我的嘉宾是博士. 理查德•巴顿, 大学医院外科重症监护主任, 和尼克·洛纳多, Pharmacy Clinical Coordinator are investigating best practices for sedation use in the ICU.
Dr. 巴顿，你在担心什么问题?
Dr. 理查德·巴顿: First, let me describe the patients that we have in the surgical and intensive care units. We can have patients with trauma, with sepsis, with major surgical complications. In other words, I'm describing to you some of the sickest patients in the world. 许多人都有不同程度的呼吸衰竭. 这些病人需要机械通气.
这到底是什么意思? 这意味着大发娱乐有一台大发娱乐病人呼吸的机器, 但为了做到这一点，这些人有气管内插管, 哪个比汽水吸管更硬更大, 比花园软管还小. 但关键是要通过病人张开的嘴, 通过他们的声带, 然后进入气管.
面试官: 很不舒服，我敢打赌.
Dr. 理查德·巴顿: 是的, 好吧, imagine what it feels like when you stick your finger down your throat; it makes you throw up. 想象一下这种感觉持续几个小时，几天，几周. 所以这很不舒服, 然而他们的生命却依赖于这些监控设备, and particularly upon the ventilator and the tube that's in their windpipe.
面试官: Sedation is important so that they can basically receive the care that they need.
Dr. 理查德·巴顿: 是的.
面试官: What can you tell us about the sedatives that are commonly used in the ICU?
Dr. 理查德·巴顿: This all 真的 began 10 years or more ago when we had patients who had received continuous infusions of benzodiazapine drugs, 谁会在几天甚至几周后才醒来.
面试官: 你还有什么要补充的吗?
尼克Lonardo: 肾功能衰竭患者, patients with liver dysfunction don't clear benzodiazepines rapidly, 这些病人有一个长期的, 几乎是一幅过度镇静的画面. 这些病人首先会说要用更长的呼吸机, because they have to be cleared mentally in order to get the endotracheal tube pulled out. 所以通过长时间使用呼吸机, this put them at risk for ventilator associated pneumonia and all of the other complications that come from being bedridden in an ICU, 起床不够早，不能走动, 有很多这样的东西. And delirium in particular, patients would stay delirious and agitated for days on end sometimes.
面试官: 这正是我想跟你说的. Something I find interesting is that benzodiazapine more frequently causes delirium and patients with long bouts of delirium are more likely to have an extended hospital stay or even die. I'm wondering what the link is between delirium and these terrible outcomes?
Dr. 理查德·巴顿: 在其他研究中也有关联, 其他情况下, 表现出精神错乱, 哪一个才是真正的思想改变, 就像精神病一样, that delirium is associated with not only poor immediate outcomes, 但实际上是心智功能的下降, 如果你愿意, 从长远来看. In other words, you don't want to be delirious for long periods of time. 它似乎永久性地改变了大脑功能.
面试官: 是精神错乱直接伤害了个人吗, 还是说，这种精神错乱预示着别的地方出了问题?
Dr. 理查德·巴顿: 我认为 that's an excellent question, and I'm not sure that I know the answer.
尼克Lonardo: 你知道吗？? 没有答案. 大发娱乐不知道. 大发娱乐根本不知道. We know that the duration of delirium that we see in the ICU is strongly independently associated with increased six month mortality. 但大发娱乐不知道其中的机制. The age old question is do you die with delirium or do you die because of it? 我不相信有人能够辨别这一点.
面试官: So you've found that patients fared better with one sedative, Propofol, than with benzodiazepines.
尼克Lonardo: 异丙酚是一种起效非常快的药物, but a very short duration of action and so it is much more predictable in terms of its sedative effects. 异丙酚可以持续使用好几天, and turn it off and your patient will awaken usually within an hour or so.
So we looked at data from 2003 through 2009 in the Project Impact Database that came out of 104 ICUs throughout the country. And when they met inclusion/exclusion criteria there were 13,692 patients. 当大发娱乐做统计的时候, we were able to see a decrease in mortality associated with the propofol group, 减少使用呼吸机的时间, 减少在ICU的时间, and increased ventilator associated pneumonias associated with the benzodiazepines. The most unexpected thing that we saw was a reduction in mortality, 这是以前没有发现的.
面试官: 这些变化正在全国范围内发生吗, 还是说执行这些建议有点棘手?
尼克Lonardo: 这是个好问题. 我看了一些调查, 我认为, 就在2006年, but at that time there were still quite a few hospitals still using benzodiazepines. The 2013 guidelines have come out from the Society of Critical Care Medicine and they have now encouraged going away from benzodiazepines for sedation and are now recommending either propofol or dexmedetomidine. 所以整个世界, 真的, of critical care is becoming more aware of the potential dangers of sedatives in the ICU.
我认为 our paper is just one more of many that have 真的 highlighted the dangers of benzodiazepines in particular, 但总的来说，我也会说过度镇静. 大发娱乐现在只给病人注射轻微的镇静剂. The standard of practice is to wake them up once or twice a day, and to try to get the patient up and walking as soon as possible, 尽可能避免使用这些神经活性药物.
Dr. 理查德·巴顿: The only thing that I would have to say is that if you're still using benzodiazepines, don't. There are 真的 better ways to sedate people, more safe ways to sedate people. 你还能大发娱乐提供你需要的镇定剂, but at the same time minimize some of the complications associated with sedation and with mechanical ventilation.
播音员: 对医疗程序有疑问吗? 想了解更多关于健康状况的知识? 大于2,与大发娱乐的医生和专家进行了000次访谈, there’s a pretty good chance you’ll find what you want to know. 去scoperadio看看吧.com.
更新日期：2019年2月26日
最初发布日期：2014年8月29日