Sedation with stimulative circadian rhythm in mechanically ventilation patients in intensive care unit

Objective To sedate the mechanically ventilation patients in intensive care unit (ICU) with simulative circadian rhythm,and evaluate whether the protocol has advantages in recovering natural circadian rhythm,duration of mechanical ventilation,and length of ICU stay after weaning of sedation.Methods A prospective random control trial was conducted.One hundred and twenty ventilated patients in ICU were randomly assigned to four groups:circadian rhythm ( CR ),daily interruption ( DI ),continuous sedation (CS) or demand sedation ( DS ) group,each n =30.Given more complications,DS group was deleted after recruiting 10 eases and 90 patients were admitted ultimately.Patients' age,gender,body weight,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) scores,sedatives dosages,daily arousal time,duration of mechanical ventilation,length of ICU stay,complications (ventilator-associated pneumonia,barotrauma with intrathoracic drain tube) and untoward reations (accidental extubation,reintubation,tracheotomy,death) were recorded,the biochemical indicators were determined,as well as number of nurses on duty at 10:00 and 22:00.Results The patients' sex ratio,age,body weight,APACHE Ⅱ scores,duration of mechanical ventilation,length of ICU stay showed no difference among CR,DI and CS groups.The total sedatives dosages (mg:5466.7 ± 620.4) and average sedatives dosages (mg·h 1·kg-1:2.19 ± 0.61 ) in CS group were significantly higher than those in CR group (4344.5 ± 816.0,1.00 ± 0.51 ) and DI group (4154.3 ± 649.4,1.23 ±0.62,all P＜0.01 ),and there was no difference between CR group and DI group.Daily arousal time in the CR group ( hours:4.40 ± 1.30) was significantly lengthened compared with that in DI group (0.59 ± 0.26 ) and CS group (0.15 ±0.02,both P＜0.05 ).The complications showed no differences in each group,but incidences of the untoward reactions in DI group ( 2 cases ) were significantly increased compared with that in CR group ( 1 case ) and CS group (0 case,P=0.0477 ).After weaning of sedation,patients with normal circadian rhythm were significantly more in CR group than that in CS group ( 19 vs.9,P=0.0339).Among CR group,DI group and CS group,there were significant differences in the numbers of nurses on duty in the daytime ( 1.65,1.41,1.14,all P＜0.01 ),but there was no difference in the night.The biochemistry index showed no difference in each group.Conclusions It demonstrated that sedation with simulative circadian rhythm be helpful to create circadian rhythm after weaning of sedation.While complications and untoward reactions did not increase,as well as duration of mechanical ventilation and length of ICU stay.Therefore,the clinical applicability of this sedative strategy was highlighted. Key words: Sedation; Propofol; Circadian rhythm; Mechanical ventilation