Intensivmedizin Fragen und Antworten

204 Kapitel 13 · Klinische Studien
tive risk [RR], 0.97; 95 % confidence interval [CI], 0.79–1.19; p=0.77). 90-day
mortality for the prone group was 43.3 % vs 42.2 % for the supine group (RR,
0.98; 95 % CI, 0.84–1.13; p=0.74). The mean (SD) duration of mechanical
ventilation was 13.7 (7.8) days for the prone group vs 14.1 (8.6) days for the
supine group (p=0.93) and the VAP incidence was 1.66 vs 2.14 episodes per
100-patients days of intubation, respectively (p=0.045). The P a O 2 /F I O 2 ratio
was significantly higher in the prone group during the 28-day follow-up. However,
pressure sores, selective intubation, and endotracheal tube obstruction
incidences were higher in the prone group.
Conclusions This trial demonstrated no beneficial outcomes and some safety
concerns associated with prone positioning. For patients with hypoxemic ARF,
prone position placement may lower the incidence of VAP.
Fazit
Die systematische Bauchlagerung bei akutem hypoxämischem Lungenversagen
verbesserte zwar die Oxygenierung, erbrachte jedoch keine Reduktion der
Beatmungsdauer und der Letalität. In der Bauchlagerungsgruppe war die Decubitusrate
und die Anzahl der Tubusprobleme erhöht.
jTägliche Unterbrechung der kontinuierlichen Sedativagabe bei
beatmeten Intensivpatienten
(n=128 Patienten, prospektive und randomisierte Studie)
Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions
in critically ill patients undergoing mechanical ventilation. N Engl J Med 342: 1471-1477
Background Continuous infusions of sedative drugs in the intensive care unit
may prolong the duration of mechanical ventilation, prolong the length of stay
in the intensive care unit and the hospital, impede efforts to perform daily
neurologic examinations, and increase the need for tests to assess alterations in
mental status. Whether regular interruption of such infusions might accelerate
recovery is not known.
Methods We conducted a randomized, controlled trial involving 128 adult
patients who were receiving mechanical ventilation and continuous infusions
of sedative drugs in a medical intensive care unit. In the intervention group, the
sedative infusions were interrupted until the patients were awake, on a daily
basis; in the control group, the infusions were interrupted only at the discretion
of the clinicians in the intensive care unit.