Effects of different early sedation levels on clinical outcomes of ICU patients with mechanical ventilation / 中国实用护理杂志

ABSTRACT

Objective:To investigate the current sedation level of patients with mechanical ventilation in ICU, and to explore the influence of early different sedation levels on clinical outcomes, so as to provide theoretical basis for better guidance of clinical sedation evaluation and implementation of sedation strategy management.Methods:This study was a retrospective longitudinal study. The 201 patients with invasive mechanical ventilation who underwent sedation in the Department of Intensive Care Medicine of the First Affiliated Hospital of Guangxi Medical University from January to December 2021 were selected by convenience sampling method. According to the results of Richmond Agitation-Sedation Scale(RASS), the patients were divided into deep sedation group (98 cases) and shallow sedation group (103 cases). The influencing factors of endotracheal intubation retention time and outcome were investigated by Cox multifactor analysis.Results:In the early sedation ≤48 h after the start of mechanical ventilation, 63.2%(2 143/3 389) of patients with invasive mechanical ventilation had a RASS score of shallow sedation, 35.2%(1 194/3 389) of patients with deep sedation, and 1.5%(52/3 389) of patients with insufficient sedation. Cox multivariate regression analysis showed that age, sedation level, duration of invasive mechanical ventilation and continuous renal replacement therapy were the factors influencing the indentation time of tracheal insertion ( χ2 values were 4.73 to 74.31, all P<0.05); early deep sedation was a risk factor for delayed extubation ( HR=0.499, 95% CI 0.276-0.903, P<0.05); gender, sedation level, invasive mechanical ventilation duration, acute physiology and chronic health evaluation Ⅱ scores, admission mode, continuous renal replacement therapywere the influencing factors of patient outcomes ( χ2 values were 4.41 to 26.20, all P<0.05). The deeper the sedation, the worse the patient outcomes ( HR=0.568, 95% CI 0.335-0.963 all P<0.05) . Conclusions:The early sedation level is related to the retention time and outcome of tracheal intubation in ICU patients with mechanical ventilation, and different sedation levels affect the clinical outcome of patients. The retention time of tracheal intubation in patients with shallow sedation was shortened, which was beneficial to the outcome of patients.Therefore, sedation evaluation should be strengthened in clinical work, and sedation methods should be selected according to the needs of patients. In the absence of contraindications, the shallow sedation strategy should be implemented as soon as possible. This study provides some reference and theoretical basis for the formulation and management of clinical sedation strategies.