ICUにおける鎮痛・鎮静に関するアンケート調査 A survey of analgesia and sedation in Japanese intensive care units

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【目的】ICUにおける鎮痛・鎮静の実状と課題を明らかにする。【方法】日本集中治療医学会専門医研修施設(219施設)に対して,2009年6月1日~30日の1ヶ月間にICUに入室したすべての成人症例の各種呼吸管理における鎮痛・鎮静と評価法の記載を依頼した。【結果】97施設から回答があった(回答率44%)。気管挿管,気管切開下の人工呼吸症例は,フェンタニル持続静注とプロポフォール持続静注が最もよく用いられており,筋弛緩薬の使用頻度は気管挿管下の症例で11%,気管切開下の症例で8%であった。非侵襲的人工呼吸症例では,デクスメデトミジンが最多であった。自発呼吸のみで管理された症例の38%,64%はそれぞれ鎮痛薬,鎮静薬を投与されていなかった。鎮痛は看護師による総合的な評価,鎮静はRichmond Agitation-Sedation Scaleによる評価が主であった。鎮痛薬の使用,1日1回の鎮静薬の中止・減量の実施,せん妄の評価は十分ではなかった。【結論】わが国のICUでの鎮痛・鎮静は,いくつかの課題はあるが,おおむね良好に行われている。

<B>Objective:</B> To evaluate current practices and problems with analgesia and sedation in Japanese ICUs using a questionnaire survey. <B>Methods:</B> Doctors, nurses, and pharmacists working in ICUs at board-certified training facilities for intensive care specialists were asked to fill out the form detailing the generic names and administration methods of analgesics, sedatives, and neuromuscular blocking agents and the assessment methods of analgesia and sedation that were used for adult patients admitted to the ICU between June 1 and 30, 2009 who received mechanical ventilation with tracheal intubation or tracheostomy, noninvasive ventilation (NIV), or no ventilatory support. <B>Results:</B> We received replies to the questionnaire from 97 ICUs (response rate: 44%). In mechanical ventilated patients with tracheal intubation or tracheostomy, the continuous intravenous administrations of fentanyl and propofol were the most frequently used analgesic and sedative, respectively, and neuromuscular blocking agents were used in about 10% of the patients. In patients with NIV, the continuous intravenous administration of dexmedetomidine was used most frequently. Thirty-eight and 64% of the patients without any ventilatory support were not administered any analgesics or sedatives, respectively. Although it was subjective, pain was mainly assessed by ICU nurses. Sedation level was mainly assessed by the Richmond Agitation-Sedation Scale. The use of analgesics, the practice of daily interruption of sedatives, and the assessment of delirium using the confusion assessment method for the ICU were unsatisfactory. <B>Conclusion:</B> Although there were some problems, the practice of analgesia and sedation in Japanese ICUs was generally acceptable.

収録刊行物

  • 日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine

    日本集中治療医学会雑誌 = Journal of the Japanese Society of Intensive Care Medicine 19(1), 99-106, 2012-01-01

    The Japanese Society of Intensive Care Medicine

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各種コード

  • NII論文ID(NAID)
    10030288339
  • NII書誌ID(NCID)
    AN10474053
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    13407988
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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