Báo cáo y học: Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives...
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Báo cáo y học: "Mechanical ventilation with lower tidal volumes does not influence the prescription of opioids or sedatives" Available online http://ccforum.com/content/11/4/R77Research Open AccessVol 11 No 4Mechanical ventilation with lower tidal volumes does notinfluence the prescription of opioids or sedativesEsther K Wolthuis1,2,3, Denise P Veelo1,2,3, Goda Choi1,3, Rogier M Determann1,Johanna C Korevaar4, Peter E Spronk1,5,6, Michael A Kuiper1,6,7 and Marcus J Schultz1,3,61Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands2Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands3Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands4Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam,The Netherlands5Department of Intensive Care Medicine, Gelre Hospitals, location Lukas, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands6HERMES Critical Care Group, Amsterdam, The Netherlands7Department of Intensive Care Medicine, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, The NetherlandsCorresponding author: Esther K Wolthuis, e.k.wolthuis@amc.uva.nlReceived: 1 May 2007 Revisions requested: 6 Jun 2007 Revisions received: 21 Jun 2007 Accepted: 13 Jul 2007 Published: 13 Jul 2007Critical Care 2007, 11:R77 (doi:10.1186/cc5969)This article is online at: http://ccforum.com/content/11/4/R77© 2007 Wolthuis et al.; licensee BioMed Central Ltd.This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroduction We compared the effects of mechanical ARDS patients declined from 9.7 ml/kg predicted body weightventilation with a lower tidal volume (VT) strategy versus those of (PBW) before to 7.8 ml/kg PBW after the intervention (P =greater VT in patients with or without acute lung injury (ALI)/ 0.007). For patients who did not have ALI/ARDS there was aacute respiratory distress syndrome (ARDS) on the use of trend toward a decline from 10.2 ml/kg PBW to 8.6 ml/kg PBWopioids and sedatives. (P = 0.073). Arterial carbon dioxide tension was significantly greater after the intervention in ALI/ARDS patients. Neither theMethods This is a secondary analysis of a previously conducted proportion of patients receiving opioids or sedatives, orbefore/after intervention study, which consisting of feedback prescriptions at individual time points differed between pre-and education on lung protective mechanical ventilation using intervention and post-intervention. Also, there were nolower VT. We evaluated the effects of this intervention on statistically significant differences in doses of sedatives andmedication prescriptions from days 0 to 28 after admission to opioids. Findings were no different between non-ALI/ARDSour multidisciplinary intensive care unit. patients and ALI/ARDS patients.Results Medication prescriptions in 23 patients before and 38 Conclusion Concerns regarding sedation requirements withpatients after intervention were studied. Of these patients, 10 use of lower VT are unfounded and should not preclude its use(44%) and 15 (40%) suffered from ALI/ARDS. The VT of ALI/ in patients with ALI/ARDS.Introduction kg predicted body weight [PBW]), as opposed to conven-One recent and substantive advance in the field of intensive tional MV using larger VT (12 ml/kg PBW), was found to resultcare medicine has been the clear demonstration by the ARDS in significant reductions in mortality and morbidity in theseNetwork investigators [1] of the benefit conferred by lung pro- patients. A recent study conducted by the same investigatorstective (LP) mechanical ventilation (MV) among patients with [2] confirmed that use of use of lower VT is associated with aacute lung injury (ALI)/acute respiratory distress syndrome low mortality rate. Despite the impressive results of the ARDS(ARDS). Specifically, LP MV with lower tidal volume (VT; 6 ml/ Network trial, many intensive care units (ICUs) have been slowALI = acute lung injury; ARDS = acute respiratory distress syndrome; FiO2 = fractional inspired oxygen; ICU = intensive care unit; LP = lung protec-tive; MV = mechanical ventilation; PaO2 = arterial oxygen tension; PBW = predicted body weight; Pmax = maximum airway pressure; RR = respiratoryrate; SEDIC = Sedation Intensive Care; VT = tidal volume. Page 1 of 9 (page number not for citation purposes)Critical Care Vol 11 No 4 Wolthuis et al.to adopt LP MV [3]. Among the reasons for not adopting LP ...