Intensivmedizin Fragen und Antworten

13 · Klinische Studien
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Results The median duration of mechanical ventilation was 4.9 days in the
intervention group, as compared with 7.3 days in the control group (p=0.004),
and the median length of stay in the intensive care unit was 6.4 days as compared
with 9.9 days, respectively (p=0.02). Six of the patients in the interven tion
group (9 %) underwent diagnostic testing to assess changes in mental status, as
compared with 16 of the patients in the control group (27 percent, p=0.02).
Complications (e.g., removal of the endotracheal tube by the patient) occurred
in three of the patients in the intervention group (4 %) and four of the patients
in the control group (7 %, p=0.88).
Conclusions In patients who are receiving mechanical ventilation, daily interruption
of sedative-drug infusions decreases the duration of mechanical ventilation
and the length of stay in the intensive care unit.
Fazit
Die tägliche Unterbrechung einer kontinuierlichen Sedativagabe bei Beatmungspatienten
reduzierte die Dauer der Beatmung und des Intensivstationsaufent haltes.
jAuswirkung der Erfassung von Patienten, die spontan atmen
können, auf deren Beatmungsdauer
(n=300 Patienten, prospektive und randomisierte Studie)
Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW,
Bowton DL, Haponik EF (1996) Effect on the duration of mechanical ventilation of identifying
patients capable of breathing spontaneously. N Engl J Med 335: 1864–9
Background Prompt recognition of the reversal of respiratory failure may permit
earlier discontinuation of mechanical ventilation, without harm to the patient.
Methods We conducted a randomized, controlled trial in 300 adult patients
receiving mechanical ventilation in medical and coronary intensive care units.
In the intervention group, patients underwent daily screening of respiratory
function by physicians, respiratory therapists, and nurses to identify those possibly
capable of breathing spontaneously; successful tests were followed by twohour
trials of spontaneous breathing in those who met the criteria. Physicians
were notified when their patients successfully completed the trials of spontaneous
breathing. The control subjects had daily screening but no other interventions.
In both groups, all clinical decisions, including the decision to discontinue
mechanical ventilation, were made by the attending physicians.
Results Although the 149 patients randomly assigned to the intervention
group had more severe disease, they received mechanical ventilation for a me-