oversedation 之惡(DIS, ABC, etc.)

NEJM開始倡導daily interruption of sedatives(2000年)

http://www.medscape.com/medline/abstract/10816184

Lancet 2008年一篇 awakening and breathing controlled trial (ABC), 倡導spontaneous awaening trial + spontaneous breathing trial

http://www.medscape.com/medline/abstract/18191684
http://www.medscape.com/viewarticle/583399


2010年 critical care , 兩個作者data mining, 搜尋pubmed的文章，做出結論是說 Intensive Care Unit-acquired Infection as a Side Effect of Sedation，oversedation是不好的
裏面提出一些mechanism,如sedation 增加microaspiration, GI motility disturbance, microcirculatory, 而動物實驗也說會有 immunomodulatory effect
(這篇文章就evidence level而言實在只是專家意見而已，不過專家意見通常最準!)
所以所以所以 -> nurse implenmenting sedation protocol, daily interruption of sedatives 應該被倡導


http://www.medscape.com/viewarticle/722413

NEJM DIS 文章
https://docs.google.com/fileview?id=0B278nGJMQBk7ZTg4ODI5OGEtYzJhNy00OTIxLTlhMWQtNGQwZDc3YTI1MWMw&hl=zh_TW

LANCET ABC 文章
https://docs.google.com/fileview?id=0B278nGJMQBk7ZDYzOWU2ZWMtZDVkNS00MTFhLWIzZDItZTg5N2YxYTE5OTQx&hl=zh_TW

critical care文章
https://docs.google.com/fileview?id=0B278nGJMQBk7NzRiNWI1YmMtZWVhOS00ZWU4LTg2YzItMDUzNDgyZGRjYTg2&hl=zh_TW

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即便是用IGRA, 有時也要等大於三個月才能決定TB contact

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TG無用論，不用吃fenofibrate了，除非> 500mg/dl

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