Study On Preventing And Controlling Of Delirium And Other Complications In ICU Ventilated Patients

Objective To investigate that if the therapy of sedation with simulative circadian rhythm is beneficial for ICU ventilated patients to decrease the occurrence of delirium and improve the clinical efficacy.Methods A prospective double-blinded randomized controlled trial(RCT) with two-factor completely random design was conducted. All the patients were given fentanyl for analgesia routinely and divided into simulated circadian clock group(Study group,n=55)and non- simulated circadian clock group(Control group,n=55).The patients in each group were subdivided into 3 subgroups according to the use of different sedatives,named dexmedetomidine group(n=15),propofol group(n=20),and dexmedetomidine combined with propofol group(Combination group,n=20). A total of 110 patients who were admitted to Department of Critical Care Medicine of the Second Hospital of Lanzhou University from January to December 2015 and undergone invasive mechanical ventilation over 12 h were enrolled. The patients were randomly assigned to the six subgroups by computing random numbers’ generation. The depth of analgesia and sedation could be quantified and controlled by using the critical-care pain abservation tool(CPOT)and Richmond agitation sedation scale(RASS). In the Study group,the RASS score was set at 0 to 1 during the daytime and 1 to-2 during the night(2200 to 0700) by titrating the dose of sedatives. In the Control group,the RASS score was set at 1 to-2 throughout the day. The incidence of delirium,ventilator associated pneumonia(VAP),severe hypotension and other complications,and the duration of mechanical ventilation,the length of ICU stay,and the sedatives dosages were recorded. The correlation between delirium and other indexes was analyzed by using Spearman correlation analysis.Results(1)There was no significant difference in age,gender,weight,height,education and acute physiology and chronic health evaluationⅡ(APACHE Ⅱ)score between the patients in the six subgroups(P>0.05);(2)Compared with the control group,the incidences of delirium,VAP,severe hypotension and bradycardia were lower in study group(12.7%vs34.5%,P=0.007;16.4%vs60%,P=0.000;16.4%vs34.5%,P=0.029;5.4%vs20%,P=0.022),while the incidences of extubation accidentally and being back to ICU were no significant difference between them(1.8%vs7.3%,1.8%vs5.5%, P>0.05);(3)Compared with the control group with the same sedative,the duration of mechanical ventilation,extubation time,the length of ICU stay and the sedatives dosages were significantly lower in the study group(all P<0.05);(4)In the study group,the duration of mechanical ventilation,extubation time and the length of ICU stay in dexmedetomidine group were shorter than that of propofol group and combination group(all P<0.05);In the control group,the length of ICU stay in dexmedetomidine group were shorter than that of combination group(P<0.05);(5)The occurrence of delirium was positively correlated with the duration of mechanical ventilation(r=0.648),extubation time(r=0.646) and the length of ICU stay(r=0.452)(all P=0.000).Conclusions Sedation with simulative circadian rhythm is beneficial for ICU ventilated patients to decrease the occurrence of delirium,VAP,severe hypotension and bradycardia,while the incidences of extubation accidentally and being back to ICU had not increased;It can shorten the duration of mechanical ventilation, extubation time and the length of ICU stay. Dexmedetomidine is helpful to improve the clinical efficacy.