ICU镇静中轻度镇静目标能否替代每日中断镇静?

Targeted Light Sedation Strategies or Daily Sedation Interruption in ICU

最近更新的有关镇痛、躁动和谵妄管理的临床实践指南中推荐应用每日镇静唤醒或轻度镇静,以期改善ICU中镇静患者的预后。多数学者将其解读为维持轻度镇静目标与每日中断镇静两者可以相互替代,即如果维持轻度镇静则无需每日中断镇静。那么两者是否可以相互替代,还是其中一种策略更具有优势,抑或两种策略同时应用更能改善ICU患者预后?本文回顾了相关文献,发现每日中断镇静和轻度镇静与ICU预后改善相关,但仍不明确是否一种策略更优于另一种策略,需进一步研究;但可以明确的是,ICU镇静要尽可能减少患者镇静药物的暴露和避免深度镇静,以保持患者处于一种轻度镇静的水平并改善其临床预后,这或许是指南推荐应用每日镇静唤醒或轻度镇静的根本所在。

The updated clinical practice guidelines for the management of pain,agitation,and delirium recommend either daily sedation interruption or maintaining light levels of sedation as methods to improve the outcomes of patients who are sedated in ICU.Many researchers interpreted the recommendation as the two strategies could be replaced by each other; that is,if you choose targeted light sedation strategies,daily sedation interruption is not necessary.We reviewed the evidences supporting both methods and discussed whether the two methods could be replaced by each other or one method is preferable or if they should be used concurrently,and noted that the daily sedation interruption and maintaining light levels of sedation are correlated with the outcomes of ICU patients,while it remains unclear as to whether one approach is superior,and further studies are needed.What is clear is that both of these strategies should achieve the minimization of patient exposure to sedative agents and the avoidance of deep sedation.For this reason,the guidelines recommend using either daily sedative interruption or targeted sedation strategies in order to maintain lighter levels of sedation in patients and to improve their clinical outcomes.