Sedation in the critically ill ventilated patient: possible role of enteral drugs

Abstract

After 24-48 h, enteral sedation may replace, totally/in part, IV sedation in ventilated patients. Total enteral sedation easily fits the target when a Ramsay score 2 is planned. When a deeper sedation is needed, a mixed regimen is effective and lowers IV drug dosages. No side effects were reported.

Bias reduction in repeated-measures observational studies by the use of propensity score: The case of enteral sedation for critically ill patients

“…Each outcome was assessed on a daily basis. As the data that we analyzed came from an observational study already published [30] and are used as an example as to how a PS approach can be implemented, we did not perform a new sample size calculation.…”

“…The population included was part of a previous study, whose results have already been published [30,31]. The ethics committee approved the original research protocol, and patients/next-of-kin gave informed consent.…”

“…Different protocols [26][27][28][29] have been proposed to achieve new targets of a lighter sedation, adequate to reach comfort in the ICU set and to reduce length of stay and costs. In previous studies [30,31], we demonstrated that enteral sedation with hydroxyzine is feasible in ventilated patients and allows us to maintain a "conscious" target (score of 2 on the Ramsay Scale [32]) for the most part of ICU stay, reducing costs. The choice between an intravenous or an enteral sedation strategy was performed every morning by the attending physician, based on a clinical basis; for this reason, multiple observation for every patient over time was collected.…”

Clonidina associada à morfina e midazolam em crianças submetidas à ventilação mecânica: estudo aleatório, duplamente encoberto e placebo controlado

“…A ineficácia apresentada pela clonidina, por via enteral, neste estudo, em potencializar os efeitos sedativos em crianças submetidas à VM, poderia ser atribuída a: a) Não efetividade do fármaco: vários estudos já demonstraram a eficácia da clonidina, tanto como sedativos 2,4,7, 18,20,[21][22][23][24][25][26][27][28] , como no tratamento da abstinência 2-4,5,9, 12,16,17,19,29 . Em alguns estudos, quando utilizada para sedação leve, a clonidina teve resultados comparáveis ao fentanil, evitando doses extras de sedativos 21 .…”

“…A clonidina é bem absorvida por via oral, atingindo uma biodisponibilidade de quase 100%. Observa-se o efeito máximo em 1 a 3 horas, com um pico de efeito sedativo em 48 a 72 horas 4,5,10,11,23 . Dessa forma, não se poderia creditar a utilização da via oral como o fator determinante para o insucesso da clonidina neste estudo; d) Interação com outras medicações: na terapia inten- .…”