Comment on “Effects of neuromuscular block on systemic and cerebral hemodynamics and bispectral index during moderate or deep sedation in critically ill patients” by Inoue et al.

Rubulotta, Francesca; G, Rubulotta; Occhipinti, Giovanna; Naimo, Jessica; Gullo, Antonino

doi:10.1007/s00134-006-0496-8

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…Most monitoring devices integrate the facial electromyography (EMG) to the EEG 26 which means that the signal is modified by the use of NMBA. 26 The nonexperienced operator should not lower the dose of sedative drugs following the initiation of NMBA because this might lead to potential risks of awareness and posttraumatic distress syndrome. 26 Propofol in combination with opioids (eg, fentanyl) are the drugs of choice for sedation in the ICU.…”

Section: Safe Intubation Using Ppes and Vlmentioning

confidence: 99%

“…26 The nonexperienced operator should not lower the dose of sedative drugs following the initiation of NMBA because this might lead to potential risks of awareness and posttraumatic distress syndrome. 26 Propofol in combination with opioids (eg, fentanyl) are the drugs of choice for sedation in the ICU. The BIS is used in a large number of studies for monitoring propofol administration only; however, the former drug is spared when conjoined with opioids to achieve the same level of sedation.…”

Section: Safe Intubation Using Ppes and Vlmentioning

confidence: 99%

“…The concomitant use of opioids will lower the BIS values and increase the sedation while the use of NMBAs will lower the BIS but it does not increase the sedation. 26 • Prolonged use of high doses of propofol can cause propofol syndrome, 32 which is dose dependent, and this is another reason why non-ICU-trained staff should use this technology to reduce the overall administration of propofol.…”

Section: Safe Intubation Using Ppes and Vlmentioning

confidence: 99%

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Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources

Rubulotta

Soliman-Aboumarie

Filbey

et al. 2020

Anesthesia &Amp; Analgesia

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Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. 1 When a patient requires intubation and invasive ventilation, the outcome is poor, 2–4 and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. 2 In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.

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Section: Safe Intubation Using Ppes and Vlmentioning

confidence: 99%

Section: Safe Intubation Using Ppes and Vlmentioning

confidence: 99%

Section: Safe Intubation Using Ppes and Vlmentioning

confidence: 99%

See 1 more Smart Citation

Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources

Rubulotta

Soliman-Aboumarie

Filbey

et al. 2020

Anesthesia &Amp; Analgesia

Self Cite

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“…Neuromuscular blockade drugs were used in all patients in order to manage the mechanical ventilation strategy (recruitment, high PEEP) as well prone positioning was used in 22% according to the recent literature on ARDS management [22,23]. Rocuronium bromide was the neuromuscular blockade used (30% of patients in mechanical ventilation) and was administered in continuous infusion, at the rate of 8 mg/h [24].…”

Section: Resultsmentioning

confidence: 99%

Sedation and analgesia in critically ill patients with COVID-19: a cohort retrospective study

2021

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Introduction: The global pandemic of novel coronavirus disease 2019 (COVID-19) began in Wuhan, China in December 2019 and spread worldwide. This retrospective study summarizes clinical experience and analgo-sedation treatment used for this novel epidemic in an Italian ICU between February to May 2020. Methods: This is a retrospective trial of 72 patients with laboratory-confirmed SARS-CoV-2 infection (COVID-19) admitted to ICU between February15, 2020 and May 15, 2020. Main Outcomes are demographic, clinical data (age, sex, medical comorbidities, respiratory supports, positive end-expiratory pressure values (PEEP), fraction of inspired oxygen (FiO2), arterial partial pressure of oxygen (PaO2), sedatives and analgesic drugs, their dosage and way of administration, medical treatments and patients mortality), ventilation strategies, sedation management in ICUs and patient mortality. Results: The mean age of the 72 patients included in the study was 69 years (SD ±12), 77% were male. All patients required respiratory support and sedation management according to different techniques of ventilation: 100% received deep sedation (RASS -4) before intubation and invasive mechanical ventilation and 19% received light sedation (RASS -1) and noninvasive ventilation). Conclusions: Of the 72 patients admitted in ICUs, 92% died. A total of 608 patients admitted to the AORN dei Colli “Naples” with confirmed COVID-19. In this restrospective study we have analyzed 72 (out of 608) patients that were admitted to intensive care due to worsening clinical conditions. All patients required tracheal intubation and mechanical ventilation with deep sedation (RASS -4), while only 19%(patients required light sedation so RASS -1) were subsequentely swiched to light sedation because of the need of compliance with non-invasive ventilation. Sedation was obtained with propofol, remifentanil, midazolam and dexmedetomidine, according to hospital guidelines.

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“…Even when one looks at clinical parameters, such as a return to spontaneous ventilation, defined as respiratory rate of more than 8/min at a tidal volume of at least 3 mL/kg for 30 s, the combination of rocuronium/sugammadex is able to achieve this in half the time as succinylcholine. 9 , 10 …”

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confidence: 99%

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Rubulotta

Soliman-Aboumarie

Filbey

et al. 2020

Anesthesia &Amp; Analgesia

Self Cite

View full text Add to dashboard Cite

Comment on “Effects of neuromuscular block on systemic and cerebral hemodynamics and bispectral index during moderate or deep sedation in critically ill patients” by Inoue et al.

Cited by 3 publications

References 5 publications

Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources

Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources

Sedation and analgesia in critically ill patients with COVID-19: a cohort retrospective study

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