Effect Of Sedation On Patients With Pulmonary Contusion Protocol-directed Weaning

ObjectiveTo implement the effect of propofol and midazolam sedation in multiple trauma patients with pulmonary contusion application of spontaneous breathing trial(SBT)implementing protocol-directed weaning, and condust an assessment on the influence of the sedative effect, successful weaning rate, complications and hospitalization cost in the hope of discussing the advandages and disadvandages of the two drugs to provide reference for clinical selection of suitable sedative drugs.MethodsThe 60 cases of multiple trauma patients with pulmonary contusion entering the ICU of the hospital during January 2014 and December 2014, requiring invasive ventilator therapy were divided into 2 groups randomly:midazolam sedation group(30cases)and propofol sedation group(30cases).On this basis,a forward-looking study was conducted on the two groups before and after weaning. Observe the two groups of patients sedation effect(Ramsay score), passive additional number of drugs and the effects on blood pressure. The use of two drugs in planning the implementation of SBT was stopped immediately to observe and compare the two groups of patients of waking time, alertness, MV, weaning time, successful weaning rate, the amount of secretion,sputum ability, ICU hospitalization duration,hospitalization cost, incidence of complications(ventilator associated pneumonia VAP, reintubation in48 hours) and death rate. In addition, a statistical analysis was performed as well.RusultsThe difference between the propofol group and the midazolam group in sedative effect(Ramsay score)and passive additional drug times was of no statistical significance(P > 0.05). The level of blood pressure in the propofol group decreased more significantly than that in the midazolam group(P < 0.05), but the duration was short,and that could be recovered after treatment.After discontinuation of the drug,the clear degree, expectoration, sedation cost was significantly higher in the propofol group than that of midazolam group(P < 0.05), while the recovery time, weaning time, discharge amount in the propofol group compared with the midazolam group, decreased significantly(P < 0.05),and the duration of MV and ICU hospitalization time, hospitalization time, cost of hospitalization in the propofol group was significantly lower or less than those of the midazolam group(P < 0.05). The successful weaning rate of the propofol group was 93.33%, higher than that of the midazolam group, 76.67%(P<0.05). The incidence of VAP in the propofol group, and the rate of re-intubation was lower than that of the midazolam group(P<0.05), but the difference about death rate in hospitalization was not statistically significant(P>0.05) between the two groupsConclusions1. After discontinuation of propofol, patients have higher awaking degree,stronger ability in sputum, and less discharge.In addition,the incidence of complications is lower, and weaning successful rate is higher,so its clinical effect is better than that of midazolam.2. Propofol sedation had a certain effect on the blood pressure, but the duration was short, and it could be recovered after treatment.3. Patients of multiple trauma patients combined with pulmonary contusion using propofol sedation in comparation with midazolam wake up quicklier, can be earlier weaned,and have less time of MV and ICU hospital duartion, which improves the utilization efficiency of medical resources.