Sedation in the Intensive Care Unit

Page, Valérie; McKenzie, C.

doi:10.1007/s40140-021-00446-5

Cited by 16 publications

(11 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Conventionally, benzodiazepines (BZDs) are the main choice for sedation, and midazolam, which has a short half-life, is also a commonly used drug. However, difficulty waking is one of the side effects, and in cases of long-term use, the level of sedation must be monitored each day in order to adjust the dosage accordingly (Page & McKenzie, 2021). At present, opioids are the main type of analgesics administered to ICU patients, among which fentanyl is common.…”

Section: Discussionmentioning

confidence: 99%

“…Sedatives and analgesics are often administered as a result (Dzierba et al, 2021). According to guidelines set by the Society of Critical Care Medicine in the US on the use of sedatives and analgesics, the indications for the use of these drugs for ICU patients are to relieve anxiety, sedate patients, induce sleep and help patients tolerate ventilators (Page & McKenzie, 2021). Without sedation or analgesia, ventilators cause great discomfort for patients, which may cause patients to refuse treatment.…”

Section: Discussionmentioning

confidence: 99%

“…At present, opioids are the main type of analgesics administered to ICU patients, among which fentanyl is common. It acts on the central nervous system, with drowsiness as a side effect (Page & McKenzie, 2021). However, research has indicated that the overuse of midazolam and fentanyl may induce coma in patients, prolong the duration of ventilator usage, and even increase mortality (Kawazoe et al, 2017; Tanios et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Retrospective study on the factors influencing the severity of pressure injuries among intensive care unit patients

Chang

Weng

2022

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims and objectives:This study investigated the factors of pressure injuries in patients in intensive care units (ICU).Background: Pressure injuries among patients in ICUs can be prevented by the early assessment of risk factors and taking appropriate preventative measures.Design: A retrospective study.Methods: ICU patients who suffered from pressure injuries between January 2016 and August 2018 at a hospital in Taiwan were selected. Patient medical histories and data associated with pressure injuries and medical treatment were collected from electronic medical records. A total of 256 patients were included in our analysis. The study adhered to the STROBE checklist.Results: A multivariate model of multinomial logistic regression analysis indicated that when compared to Stage 1 pressure injuries, Stage 2-4 pressure injuries were associated with albumin levels. Patients with lower albumin levels were at greater odds of Stage 2-4 pressure injuries than Stage 1 pressure injuries. In addition, when compared to unstageable pressure injuries or deep tissue injuries, Stage 1 pressure injuries were associated with the use of fentanyl and haemoglobin levels. Patients using fentanyl were more likely to suffer from unstageable pressure injuries, and those with lower haemoglobin levels were more likely to suffer from unstageable pressure injuries or deep tissue injuries. Conclusion:When patients were simultaneously on ventilators and taking midazolam or fentanyl, the incidence of pressure injuries with greater severity became higher.Furthermore, ICU patients with lower albumin and haemoglobin levels were more likely to suffer from pressure injuries of greater severity.Relevance to clinical practice: For critically ill patients on ventilators, it is recommended to devise a means of assessing each patient daily as well as systematically reduce their dosage of midazolam or fentanyl. Furthermore, regularly monitoring albumin and haemoglobin levels to understand their nutritional status is necessary.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Retrospective study on the factors influencing the severity of pressure injuries among intensive care unit patients

Chang

Weng

2022

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…Therefore, the development of evidence–based deep sedation indications is critical to avoiding unjustified deep sedation practices in MV patients. As the basis for this task, it is necessary to investigate stressful stimuli, sedative choice (either type or dosage), and patient tolerability as well as their interactions in further research studies ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Deep Sedation Practice in Mechanically Ventilated Patients: A Post hoc Analysis of a Cross–Sectional Survey Combined With a Questionnaire for Physicians on Sedation Practices

Wang²,

Gong

et al. 2022

Front. Med.

View full text Add to dashboard Cite

PurposeThe study aimed to explore factors associated with deep sedation practice in intensive care units (ICUs).Materials and MethodsA post hoc analysis was conducted for a cross–sectional survey on sedation practices in mechanically ventilated (MV) patients, combined with a questionnaire for physicians regarding their preferences for light sedation (P–pls Score) in 92 Chinese ICUs.ResultsThere were 457 and 127 eligible MV patients in the light and deep sedation groups respectively. A multivariable logistic regression analysis demonstrated that the control mode of mechanical ventilation, plasma lactate level, and the Sequential Organ Failure Assessment (SOFA) score were independent risk factors for deep sedation practice (p <0.01). Notably, the adjusted odds ratio (95% CI) of the average P–pls score in the ICU ≤ 2 for deep sedation practice was 1.861 (1.163, 2.978, p = 0.01). In addition, the areas under curves of receiver operating characteristics (AUC–ROC) of the model to predict the probability of deep sedation practice were 0.753 (0.699, 0.806) and 0.772 (0.64, 0.905) in the training set and the validation set, respectively. The 28–day mortality was increased in patients with exposure to deep sedation practice but not significantly.ConclusionBoth factors related to stressful stimuli and the ICU physicians' perception of patient tolerability in mechanical ventilation were likely associated with deep sedation practice in MV patients.

show abstract

“…For instance, sedatives could be overused while maintaining the level of sedation at RASS−2 for MV patients ready for weaning. On the other hand, the sedation depth at RASS−3 (or even the deeper levels) might be necessary for acute critically ill patients with multiple organ dysfunction caused by aggressive inflammatory responses ( 63 , 64 ). In fact, no consensus on the definitions of deep sedation and oversedation is available because of gaps in the evidence.…”

Section: Recognition Estimation and Prevention Of Oversedation In MV Patientsmentioning

confidence: 99%

Tools Are Needed to Promote Sedation Practices for Mechanically Ventilated Patients

Wang¹,

Zhou²,

Zhang

et al. 2021

Front. Med.

View full text Add to dashboard Cite

Suboptimal sedation practices continue to be frequent, although the updated guidelines for management of pain, agitation, and delirium in mechanically ventilated (MV) patients have been published for several years. Causes of low adherence to the recommended minimal sedation protocol are multifactorial. However, the barriers to translation of these protocols into standard care for MV patients have yet to be analyzed. In our view, it is necessary to develop fresh insights into the interaction between the patients' responses to nociceptive stimuli and individualized regulation of patients' tolerance when using analgesics and sedatives. By better understanding this interaction, development of novel tools to assess patient pain tolerance and to define and predict oversedation or delirium may promote better sedation practices in the future.

show abstract

Sedation in the Intensive Care Unit

Cited by 16 publications

References 51 publications

Retrospective study on the factors influencing the severity of pressure injuries among intensive care unit patients

Retrospective study on the factors influencing the severity of pressure injuries among intensive care unit patients

Factors Associated With Deep Sedation Practice in Mechanically Ventilated Patients: A Post hoc Analysis of a Cross–Sectional Survey Combined With a Questionnaire for Physicians on Sedation Practices

Tools Are Needed to Promote Sedation Practices for Mechanically Ventilated Patients

Contact Info

Product

Resources

About