Maintaining light sedation is important: next steps for research

Devlin, John W.; Seth, Bhavna; Train, Sarah

doi:10.1136/thoraxjnl-2021-217337

Cited by 2 publications

(3 citation statements)

References 16 publications

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“…Finally, though the intervention group achieved lighter sedation, patients did not receive less sedation overall. Discordance between sedative exposure and sedation level has been documented before (33, 34). However, this fact illustrates that benefit may have been driven by other factors, such as better overall care (i.e., unmeasured confounders and Hawthorne effect), or other components of the intervention, such as improved sedation documentation.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Implementing Targeted SEDation in Mechanically Ventilated Emergency Department Patients: The ED-SED Pilot Trial

Fuller

Roberts

Mohr

et al. 2022

Critical Care Medicine

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Deep sedation in the emergency department (ED) is common, increases deep sedation in the ICU, and is negatively associated with outcome. Limiting ED deep sedation may, therefore, be a high-yield intervention to improve outcome. However, the feasibility of conducting an adequately powered ED-based clinical sedation trial is unknown. Our objectives were to assess trial feasibility in terms of: 1) recruitment, 2) protocol implementation and practice change, and 3) safety. Patient-centered clinical outcomes were assessed to better plan for a future large-scale clinical trial. DESIGN: Pragmatic, multicenter (n = 3), prospective before-after pilot and feasibility trial.

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Section: Discussionmentioning

confidence: 99%

The Feasibility of Implementing Targeted SEDation in Mechanically Ventilated Emergency Department Patients: The ED-SED Pilot Trial

Fuller

Roberts

Mohr

et al. 2022

Critical Care Medicine

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“…Finally, significant complications such as ischemic and hemorrhagic stroke could be masked by deep sedation, as illustrated in a recent case series of patients with severe coronavirus disease 2019 (COVID-19) ARDS [22]. Because of these potentially important impacts of sedation on outcomes, 2018 Pain, Agitation/Sedation, Delirium, Immobility, Sleep Disruption (PADIS) guidelines recommended that light sedation should be pursued in mechanically ventilated patients whenever feasible [2,23].…”

Section: Introductionmentioning

confidence: 99%

“…Several recent studies found links between adverse brain states (burst suppression, coma) and mortality [ [22]. Because of these potentially important impacts of sedation on outcomes, 2018 Pain, Agitation/Sedation, Delirium, Immobility, Sleep Disruption (PADIS) guidelines recommended that light sedation should be pursued in mechanically ventilated patients whenever feasible [2,23].…”

Section: Introductionmentioning

confidence: 99%

Monitoring of sedation in mechanically ventilated patients using remote technology

Hanidziar

Westover

2022

Current Opinion in Critical Care

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Purpose of reviewTwo years of coronavirus disease 2019 (COVID-19) pandemic highlighted that excessive sedation in the ICU leading to coma and other adverse outcomes remains pervasive. There is a need to improve monitoring and management of sedation in mechanically ventilated patients. Remote technologies that are based on automated analysis of electroencephalogram (EEG) could enhance standard care and alert clinicians real-time when severe EEG suppression or other abnormal brain states are detected.Recent findingsHigh rates of drug-induced coma as well as delirium were found in several large cohorts of mechanically ventilated patients with COVID-19 pneumonia. In patients with acute respiratory distress syndrome, high doses of sedatives comparable to general anesthesia have been commonly administered without defined EEG endpoints. Continuous limited-channel EEG can reveal pathologic brain states such as burst suppression, that cannot be diagnosed by neurological examination alone. Recent studies documented that machine learning-based analysis of continuous EEG signal is feasible and that this approach can identify burst suppression as well as delirium with high specificity.SummaryPreventing oversedation in the ICU remains a challenge. Continuous monitoring of EEG activity, automated EEG analysis, and generation of alerts to clinicians may reduce drug-induced coma and potentially improve patient outcomes.

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Maintaining light sedation is important: next steps for research

Cited by 2 publications

References 16 publications

The Feasibility of Implementing Targeted SEDation in Mechanically Ventilated Emergency Department Patients: The ED-SED Pilot Trial

The Feasibility of Implementing Targeted SEDation in Mechanically Ventilated Emergency Department Patients: The ED-SED Pilot Trial

Monitoring of sedation in mechanically ventilated patients using remote technology

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