Study on the early goal-directed sedation combined with RASS score in the application of patients with severe traumatic brain injury

ObjectiveTo explore the effects of early goal-directed sedation(EGDS) strategy combined with RASS score in the application of patients with severe traumatic brain injury.

MethodsSeventy-four patients with severe traumatic brain injury were randomly divided into the EGDS group(36 cases) and control group(38 cases).The sedative drug dexmedetomidine hydrochloride injection was used to implement the EGDS strategy in EGDS group, the midazolam injection was used as the leading sedative for routine sedation in control group, and the sedation goal was to maintain a RASS score of -2 to 1.The rate of reaching the standard of light sedation within 12 hours and proportion of patients with light sedation after 30 minutes and 1 hour of sedation were compared between two groups.The mean arterial pressure, heart rate and respiratory rate between two groups were compared before and after sedation.

ResultsAfter 12 hours of continuous sedation, the differences of the proportions of light sedation, deep sedation and restlessness between two groups were statistically significant(P < 0.05).After 30 minutes of sedation treatment, the proportion of light sedation patients in EGDS group(54.55%) was higher than that in control group(13.33%)(P < 0.05).After 1h of sedation treatment, the proportion of light sedation patients in EGDS group(77.27%) was higher than that in control group(33.33%)(P < 0.05).There was no statistical significance in the mean arterial pressure, heart rate and respiratory frequency between two groups before treatment(P>0.05).There was no statistical significance in the heart rate and respiratory frequency between two groups after treatment(P>0.05), but the mean arterial pressure in control group was significantly lower than that in EGDS group(P < 0.05).After treatment, the respiratory frequency and heart rate in two groups were significantly lower than those before treatment(P < 0.01).

ConclusionsCompared with standardized sedation strategy, the early goal-directed sedation combined with RASS score in the application of patients with severe traumatic brain injury is relatively safe and feasible, can achieve early light sedation goals with high comfort, quiet coordination and less intervention for vital signs, and has extensive clinical application prospect in clinic.