Analgesia and Sedation in Intensive Care

Aitkenhead, A. R.

doi:10.1093/bja/63.2.196

Cited by 61 publications

(23 citation statements)

References 51 publications

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“…Complications are likely to arise mainly during extended treatment. 6 In extended sedation, immobility is associated with negative nitrogen balance 1 and increased incidence of lesions in nerves or skin due to the decubitus position. 7 In the present data, we did not observe any difference in the incidence of deep vein thrombosis between the two groups, and this may have been because of the intensive nursing care.…”

Section: Discussionmentioning

confidence: 99%

Influence of sedation on morbidity and mortality in the intensive care unit

Rodrigues

Amaral

2004

Sao Paulo Med. J.

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CONTEXT: Although 30 to 50% of hospitalized patients in a critical care unit are under sedation, there is sparse data on the impact of sedation on morbidity and case-fatality rates in Brazil. Sedation is associated with higher risks of infection and death rate among patients. However, it is difficult to assess the clinical impact of sedation. OBJECTIVE: To evaluate the impact of sedation on the incidence of nosocomial infection and all-cause deaths at a critical care unit. TYPE OF STUDY: Prospective study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: After the exclusion of patients hospitalized for less than 24 hours, 307 patients were assigned to two groups, considering their states of sedation. After confirmation of heterogeneity in relation to the Acute Physiology and Chronic Health Evaluation (APACHE II) prognostic system, 97 sedated and 97 non-sedated patients were matched in relation to this severity index. MAIN MEASUREMENTS: Impact of sedation on deep venous thrombosis, incidence of decubital eschars, presence of infection, mortality and length of hospital stay. RESULTS: There was no difference in the incidence of deep venous thrombosis between the sedated and non-sedated groups, while the frequency of decubital eschars was significantly higher among sedated patients (p = 0.03). Infection was detected in 45.4% of patients under sedation and 21.6% of patients not under sedation (p = 0.006). Mortality for patients that did not receive any kind of sedative was 20.6% and, for those that were sedated during hospitalization, the rate was 52.6% (p < 0.0001). The sedated patients had longer hospitalization (11 vs. 4 days) (p < 0.0001). CONCLUSION: We concluded that sedation is associated with higher infection risk and case-fatality rate, and longer hospital stay.

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Section: Discussionmentioning

confidence: 99%

Influence of sedation on morbidity and mortality in the intensive care unit

Rodrigues

Amaral

2004

Sao Paulo Med. J.

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“…A escolha do agente hipnótico recai, geralmente, sobre o midazolam, principalmente pela hidrossolubilidade, curta meia-vida de eliminação e custo relativamente baixo. O propofol demonstra uma série de propriedades adequadas para sedação em UTI, como meia-vida de ação extremamente curta, mesmo em infusões prolongadas, e pode ser melhor opção que o midazolam em uma série de situações 10,17,18 . Sua grande limitação encontra-se, ainda, no custo.…”

Section: Métodounclassified

“…Sua grande limitação encontra-se, ainda, no custo. Haloperidol foi empregado na agitação psicomotora e é preferido no tratamento do delírio, segundo consenso das SCCM e ACCCM 23 ; tiobarbiturato de sódio ("coma barbitúri-co"), no controle da hipertensão intracraniana e do sofrimento neurológico 2, 10,17 ; propofol em injeção contínua para sedação de pacientes respirando artificialmente, sendo sua baixa utilização, nesta pesquisa, devido às poucas unidades adquiridas pelo nosocômio em questão. Diazepam, haloperidol, tiopental e propofol somados corresponderam a 19,5% de todas as técnicas empregadas na sedação dos pacientes desta pesquisa.…”

Section: Métodounclassified

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Experiência clínica com o uso de sedativos em terapia intensiva: estudo retrospectivo

Júnior¹,

Amaral

2002

Rev. Bras. Anestesiol.

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Justificativa e Objetivos Background and Objectives -Among the most frequent indications for Intensive Care Unit patients sedation, one may mention artificial ventilation installation and maintenance, anxiety and uncomfortable or painful procedures. This retrospective study aimed at evaluating most common sedation indications and techniques for severe patients admitted to the Surgical Int e n s i v e C a r e U n i t , E s c o l a P a u l i s t a d e M e d i c i n a (EPM/UNIFESP) during an 11-month period. Methods -After excluding patients remaining in the ICU for less than 24 hours and those without the necessary evaluation to determine their severity index (APACHE II)

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“…Some sedatives or their metabolites can exhibit long-acting effects, and these problems are usually enhanced in the presence of renal and/or hepatic failure [14,15]. Central nervous system disorders (stroke, bleeding, postneurosurgical status, infectious diseases, such as meningitis or encephalitis, etc.)…”

Section: Physiopathological Mechanisms To Explain Difficult Weaningmentioning

confidence: 99%

Weaning from mechanical ventilation

Mancebo

1996

Eur Respir J

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W We ea an ni in ng g f fr ro om m m me ec ch ha an ni ic ca al l v ve en nt ti il la at ti io on n J. ManceboWeaning from mechanical ventilation. J. Mancebo. ERS Journals Ltd 1996. ABSTRACT: Weaning from mechanical ventilation is a period of transition from total ventilatory support to spontaneous breathing. It represents a relevant clinical problem because as many as 25% of intubated and mechanically-ventilated critically ill patients will need a progressive withdrawal from artificial ventilatory support.From a clinical standpoint, it is very important to recognize as soon as possible when a patient is ready to be weaned. Accordingly, a daily routine follow-up should be performed in every patient in order to verify whether patients meet clinical criteria to be disconnected from the ventilator. Several physiological indices have been used to predict the outcome of weaning trials. However, an adequate clinical tolerance to spontaneous breathing during a 2 h T-piece trial is very useful to predict a successful extubation.A number of physiopathological mechanisms explain why some patients fail the weaning trials; particularly important from a clinical point of view are those related to respiratory pump failure and cardiovascular instability, which are usually accompanied by an abnormal gas exchange.Different ventilatory techniques can be used to wean these patients from mechanical ventilation. Up to now, the most efficient techniques seem to be pressure support ventilation and once daily trials of T-piece interspersed with conventional volume assist-control ventilation.Finally, knowledge-based system applied to modern microprocessor mechanical ventilators can help in the process of weaning by automatically reducing the ventilatory assistance and indicating the optimal time to perform extubation.

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Analgesia and Sedation in Intensive Care

Cited by 61 publications

References 51 publications

Influence of sedation on morbidity and mortality in the intensive care unit

Influence of sedation on morbidity and mortality in the intensive care unit

Experiência clínica com o uso de sedativos em terapia intensiva: estudo retrospectivo

Weaning from mechanical ventilation

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