Application Of Nurse-led Early Target-directed Sedation Strategy In Patients With Mechanical Ventilation In ICU

ObjectiveTo explore the applicability and feasibility of "Nurse-led Early Goal-d irected Sedation Strategy(EGDS)" for sedation management of mechani cal ventilation patients in ICU,and to reduce the dosage of sedatives,d uration of mechanical ventilation,length of stay in ICU and total length of hospitalization,as well as the incidence of adverse events,so as to i mprove the clinical prognosis of mechanical ventilation patients,promote their sedation management and the patient recovered.MethodsThis study is a prospective,double-blind study,using cluster sampli ng method,selected patients with mechanical ventilation admitted to the intensive care unit of the First Affiliated Hospital of Jinzhou Medical Un iversity from March 2017 to December 2018 as the research object.Pat ientswere divided into experimental group and control group according to the method of sectional randomization.Both groups were sedated on t he basis of adequate analgesia.The experimental group adopted EGDS strategy.The first choice was dexmedetomidine to continue intravenous infusion at the rate of 1 ug kg-1 h-1.The nurses were given Richmon d restlessness-sedation score(RASS)once every 4 hours and adjusted the dosage of sedative drugs in time.If RASS 2,propofol and midazolam were added;if RASS 3,dexmedetomidine was continuously quiet at t he rate of 0.2 UG kg-1 H-1 per 30 minutes.Pulse infusion was used u ntil the RASS score was between-2 and 0,and sedation was stopped.The control group was sedated with propofol,dexmedetomidine and mi dazolam,and the RASS score was maintained between-2 and-3.O n the basis of no statistical difference in general data between the two groups,the dosage of sedatives,duration of mechanical ventilation,ICU stay,total hospitalization time,delirium,accidental extubation and ICU death were observed,and the prognosis of mechanical ventilation patien ts in the two groups under different strategies was compared.ResultsA total of 137 patients with clinical mechanical ventilation were enro lled in this study.66 patients in the experimental group and 71 patients in the control group were enrolled.There was no significant difference between the two groups in general data such as gender,age,acute ph ysiology and chronic health status score II(APACHE II),basic diseases andso on(P > 0.05).Compared with the control group,the total doses of dexmedetomidine,propofol and midazolam per capita in the experim ental group were significantly lower [dexmedetomidine(ug): 154.45(+27.86)vs378.85(+39.76),propofol(mg): 4490.03(+479.88)vs 7349.76(+814.31),midazolam(mg): 255.38(+46.24)vs 562.79(+97.26),all P < 0.01].Theduration of mechanical ventilation,stay in ICU and hospitalization were significantly longer.[Mechanical ventilation time(d): 7.68 + 3.31 v s.11.72 +3.63,ICU(d): 10.17 + 3.88 vs.19.21 + 4.05,total hospitaliza tion time(d): 29.91 + 4.57 vs.50.41 + 9.11,all P < 0.01].Kaplan-Meie r survival analysis showed that the incidence of delirium in the experime ntal groupwas significantly lower than that in the control group(log-rank_=5.481,P< 0.05);there was no significant difference in the rate of accidental extubation and ICU mortality between the two groups(log-rank_=0.078,0.999,all P > 0.05).ConclusionsThe results showed that "Nurse-led Early Goal-directed Sedation Str ategy(EGDS)" was suitable for mechanical ventilation patients in ICU.T he strategy reduced the dosage of sedatives used in mechanical ventilat ion patients,shortened the duration of mechanical ventilation,ICU stay and total hospital stay,and reduced the incidence of delirium.Therefore,the goal of shallow sedation was achieved and the objective of shallow sedation strategy was realized.Standard,improve the clinical prognosis of patients with mechanical ventilation,and promote the rehabilitation of patients.