KMID : 0383820120730030151
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Tuberculosis and Respiratory Diseases 2012 Volume.73 No. 3 p.151 ~ p.161
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The Significance of Sedation Control in Patients Receiving Mechanical Ventilation
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Jung Yun-Jung
Chung Wou-Young Lee Mi-Yeon Lee Keu-Sung Park Joo-Hun Sheen Seung-Soo Hwang Sung-Chul Park Kwang-Joo
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Abstract
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Background: Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation.
Materials and Methods: A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS) was conducted in the SAG.
Results: In the SAG, the dose of midazolam was significantly reduced by control of sedation (day 1, 1.3¡¾0.5 ¥ìg/kg/min; day 2, 0.9¡¾0.4¥ìg/kg/min; p£¼0.01), and was significantly lower than the ECG on day 2 (p£¼0.01). Likewise, on day 2, sedation levels were significantly lower in the SAG than in the ECG. Significant relationship was found between Ramsay sedation scale and Richmond agitation-sedation scale (RASS; rs=?0.57), Ramsay Sedation Scale and Bispectral Index (BIS; rs=0.77), and RASS and BIS (rs=?0.79). In 10 patients, who didn¡¯t require re-sedation after DIS, BIS showed the earliest and most significant changes among the sedation scales. Ventilatory parameters showed significant but less prominent changes, and hemodynamic parameters didn¡¯t show significant changes. No seriously adverse events ensued after the implementation of DIS.
Conclusion: Active assessment and control of sedation significantly reduced the dosage of sedatives in patients receiving mechanical ventilation. DIS, conducted in limited cases, suggested its potential efficacy and tolerability.
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KEYWORD
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Conscious Sedation, Ventilators, Mechanical, Hypnotics and Sedatives, Consciousness Monitors
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