ICU sedation: Difference between revisions
Ostermayer (talk | contribs) (Text replacement - "Category:Drugs" to "Category:Pharmacology") |
|||
| (3 intermediate revisions by 2 users not shown) | |||
| Line 2: | Line 2: | ||
*Sedation is commonly used for ICU patients | *Sedation is commonly used for ICU patients | ||
*Agent choice determined by side effect profile and disease process | *Agent choice determined by side effect profile and disease process | ||
*Common ICU uses | |||
* | **Control agitation | ||
* | **Improve patient-ventilator synchrony | ||
* | **Decreases O2 consumption | ||
**Decrease intracranial pressure | |||
*Decreases O2 consumption | *For intubated and mechanically ventilated patients who are unable to clearly communicate the source of agitation, analgesia should always be provided first<ref>https://journals.lww.com/ccmjournal/Fulltext/2018/09000/Clinical_Practice_Guidelines_for_the_Prevention.29.aspx</ref> | ||
*Decrease intracranial pressure | |||
==Agents== | ==Agents== | ||
| Line 18: | Line 17: | ||
**[[Midazolam]] | **[[Midazolam]] | ||
**[[Lorazepam]] | **[[Lorazepam]] | ||
*[[Dexmedetomidine]] | *[[Dexmedetomidine]] → useful as adjunct treatment for severe alcohol withdrawal in the ICU; associated with a reduction in short-term alcohol withdrawal symptoms in ICU patients<ref>Beg, M., Fisher, S., Siu, D., Rajan, S., Troxell, L., & Liu, V. X. (2016). Treatment of Alcohol Withdrawal Syndrome with and without Dexmedetomidine. The Permanente journal, 20(2), 49–53. https://doi.org/10.7812/TPP/15-113</ref> | ||
*[[Ketamine]] | *[[Ketamine]] | ||
*[[Haloperidol]] | *[[Haloperidol]] | ||
==Adverse Effects== | ==Adverse Effects== | ||
| Line 30: | Line 29: | ||
**Arrhythmias | **Arrhythmias | ||
==Monitoring== | ==Monitoring of Sedation== | ||
*Several sedation monitoring scales are validated | *Several sedation monitoring scales are validated | ||
*Richmond Agitation and Sedation Scale most commonly used ([http://ccn.aacnjournals.org/content/23/2/25/T3.large.jpg RASS]) | *Richmond Agitation and Sedation Scale (RASS) most commonly used ([http://ccn.aacnjournals.org/content/23/2/25/T3.large.jpg RASS]) | ||
* | *The [https://doi.org/10.1002/ejp.880 COMFORT scale] is a valid and reliable system for assessing sedation, distress, and pain in nonverbal pediatric patients | ||
==Considerations== | ==Considerations== | ||
*Lighter sedation associated with shorter ICU stay, decreased time on ventilator<ref> | |||
Jacobi, J., Fraser, G. L., Coursin, D. B., Riker, R. R., Fontaine, D., Wittbrodt, E. T., Chalfin, D. B., Masica, M. F., Bjerke, S. H., Coplin, W. M., Crippen, D. W., Fuchs, B. D., Kelleher, R. M., Marik, P. E., Nasraway, S. A., Murray, M. J., Peruzzi, W. T. and Lumb, P. D. (2002) ‘Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult’, Critical Care Medicine, 30(1), pp. 119–141.</ref> | |||
*Deeper sedation associated with prolonged ICU stay, increased 6 month mortality<ref>Shehabi, Y., Bellomo, R., Reade, M. C., Bailey, M., Bass, F., Howe, B., McArthur, C., Seppelt, I. M., Webb, S. and Weisbrodt, L. (2012) ‘Early Intensive Care Sedation Predicts Long-Term Mortality in Ventilated Critically Ill Patients’, American Journal of Respiratory and Critical Care Medicine, 186(8), pp. 724–731.</ref> | *Deeper sedation associated with prolonged ICU stay, increased 6 month mortality<ref>Shehabi, Y., Bellomo, R., Reade, M. C., Bailey, M., Bass, F., Howe, B., McArthur, C., Seppelt, I. M., Webb, S. and Weisbrodt, L. (2012) ‘Early Intensive Care Sedation Predicts Long-Term Mortality in Ventilated Critically Ill Patients’, American Journal of Respiratory and Critical Care Medicine, 186(8), pp. 724–731.</ref> | ||
*Dexmedetomidine or propofol sedation may reduce ICU stay, time on ventilator, when compared with benzodiazepines<ref>Fraser, G. L., Devlin, J. W., Worby, C. P., Alhazzani, W., Barr, J., Dasta, J. F., Kress, J. P., Davidson, J. E. and Spencer, F. A. (2013) ‘Benzodiazepine Versus Nonbenzodiazepine-Based Sedation for Mechanically Ventilated, Critically Ill Adults’, Critical Care Medicine, 41pp. 30–38.</ref> | *Dexmedetomidine or propofol sedation may reduce ICU stay, time on ventilator, when compared with benzodiazepines<ref>Fraser, G. L., Devlin, J. W., Worby, C. P., Alhazzani, W., Barr, J., Dasta, J. F., Kress, J. P., Davidson, J. E. and Spencer, F. A. (2013) ‘Benzodiazepine Versus Nonbenzodiazepine-Based Sedation for Mechanically Ventilated, Critically Ill Adults’, Critical Care Medicine, 41pp. 30–38.</ref> | ||
| Line 42: | Line 42: | ||
==See Also== | ==See Also== | ||
*[[Sedation ( | *[[Sedation (main)]] | ||
==References== | ==References== | ||
Latest revision as of 20:24, 29 March 2022
Background
- Sedation is commonly used for ICU patients
- Agent choice determined by side effect profile and disease process
- Common ICU uses
- Control agitation
- Improve patient-ventilator synchrony
- Decreases O2 consumption
- Decrease intracranial pressure
- For intubated and mechanically ventilated patients who are unable to clearly communicate the source of agitation, analgesia should always be provided first[1]
Agents
- Propofol
- Opioids
- Benzodiazepines
- Dexmedetomidine → useful as adjunct treatment for severe alcohol withdrawal in the ICU; associated with a reduction in short-term alcohol withdrawal symptoms in ICU patients[2]
- Ketamine
- Haloperidol
Adverse Effects
- Drug and dose dependent, but generally include:
- Hypotension
- Respiratory depression
- Withdrawal
- Delirium
- Arrhythmias
Monitoring of Sedation
- Several sedation monitoring scales are validated
- Richmond Agitation and Sedation Scale (RASS) most commonly used (RASS)
- The COMFORT scale is a valid and reliable system for assessing sedation, distress, and pain in nonverbal pediatric patients
Considerations
- Lighter sedation associated with shorter ICU stay, decreased time on ventilator[3]
- Deeper sedation associated with prolonged ICU stay, increased 6 month mortality[4]
- Dexmedetomidine or propofol sedation may reduce ICU stay, time on ventilator, when compared with benzodiazepines[5]
- SCCM Recommendation, level 2B (weak recommendation)[6]
See Also
References
- ↑ https://journals.lww.com/ccmjournal/Fulltext/2018/09000/Clinical_Practice_Guidelines_for_the_Prevention.29.aspx
- ↑ Beg, M., Fisher, S., Siu, D., Rajan, S., Troxell, L., & Liu, V. X. (2016). Treatment of Alcohol Withdrawal Syndrome with and without Dexmedetomidine. The Permanente journal, 20(2), 49–53. https://doi.org/10.7812/TPP/15-113
- ↑ Jacobi, J., Fraser, G. L., Coursin, D. B., Riker, R. R., Fontaine, D., Wittbrodt, E. T., Chalfin, D. B., Masica, M. F., Bjerke, S. H., Coplin, W. M., Crippen, D. W., Fuchs, B. D., Kelleher, R. M., Marik, P. E., Nasraway, S. A., Murray, M. J., Peruzzi, W. T. and Lumb, P. D. (2002) ‘Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult’, Critical Care Medicine, 30(1), pp. 119–141.
- ↑ Shehabi, Y., Bellomo, R., Reade, M. C., Bailey, M., Bass, F., Howe, B., McArthur, C., Seppelt, I. M., Webb, S. and Weisbrodt, L. (2012) ‘Early Intensive Care Sedation Predicts Long-Term Mortality in Ventilated Critically Ill Patients’, American Journal of Respiratory and Critical Care Medicine, 186(8), pp. 724–731.
- ↑ Fraser, G. L., Devlin, J. W., Worby, C. P., Alhazzani, W., Barr, J., Dasta, J. F., Kress, J. P., Davidson, J. E. and Spencer, F. A. (2013) ‘Benzodiazepine Versus Nonbenzodiazepine-Based Sedation for Mechanically Ventilated, Critically Ill Adults’, Critical Care Medicine, 41pp. 30–38.
- ↑ Barr, J., Fraser, G. L., Puntillo, K., Ely, W. E., Gélinas, C., Dasta, J. F., Davidson, J. E., Devlin, J. W., Kress, J. P., Joffe, A. M., Coursin, D. B., Herr, D. L., Tung, A., Robinson, B. R. H., Fontaine, D. K., Ramsay, M. A., Riker, R. R., Sessler, C. N., Pun, B., Skrobik, Y. and Jaeschke, R. (2013) ‘Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit’, Critical Care Medicine, 41(1), pp. 278–280.