The Value Of A Strategy Of Early No Sedation For Intubated Mechanically Ventilated Patients In Respiratory Intensive Care Unit(RICU)

Objective To ascertain the value of early(mechanical ventilation after 24h) no sedation for intubated mechanically ventilated patients in respiratory intensive care unit(RICU).Method We randomly assigned 70 intubated mechanically ventilated patients in RICU to management with early no sedation(intervention group; n=35)or with daily interruption of sedation(DIS)(control group; n=35). Duration of mechanical ventilation, length of RICU stay and hospital stay, RICU and hospital mortality, drug consumption, RICU and hospitalization expenses, ventilator-associated pneumonia(VAP), adverse event rates were recorded and compared. Myocardial enzyme, NT-pro BNP, liver function, renal function, C-reactive protein and lactate levels were also recorded on the day of mechanical ventilation time for 48 h.Results Patients from the early no sedation group had a shorter duration of mechanical ventilation(d) than those in the DIS group(7±5 vs 11±9, P<0.05) and were discharged from RICU(d)(9±7 vs 18±9, P<0.05) ] and the hospital(d) earlier(17±14 vs 29±22, P<0.05) ]. The doses of midazolam(mg) were significantly lower in the early no sedation group compared with the DIS group(98.7±104.2 vs 481.6±336.6, P<0.05)]. The RICU and hospitalization expenses(yuan) were both significantly decreased in the early no sedation group compared with the DIS group(95928±98146 vs 172319±188124, 130843±115929 vs 246473±270248, P<0.05)]. In the early no sedation group, the occurrences of VAP(23%vs 46%), tracheotomy(14% vs 37%) and gastrointestinal adverse reactions(17%vs 40%) were significantly decreased compared with those in the DIS group(P<0.05). No difference was recorded in RICU and hospital mortality(P>0.05). The doses of dezocine, the occurrences of unplanned extubation, reintubati and the need for CT brain scans were similar in the two groups(P>0.05). The levels of troponin?creatine kinase-MB?myoglobin?NT-pro BNP?total protein?albumin?glutamic-pyruvic transaminase?glutamic oxalacetic transaminase?blood urea nitrogen?creatinine?C-reactive protein and lactic acid were the same in both groups(P>0.05).Conclusions In patients who are receiving intubated mechanical ventilation, early no sedation decreases the duration of mechanical ventilation, the length of stay in RICU and hospital, doses of sedative, the rate of tracheotomy, VAP, gastrointestinal adverse reactions and medical expenses, but it didn't increase the adverse event rates, the mortality in RICU and hospital and the occurrences of delirium and early organ failure.