Sedation and Analgesia for the Mechanically Ventilated Patient

Clinics in Chest Medicine

Volumn 30, Issue 1, 2009, Pages 131-141

  Brush, David R ^a   Kress, John P ^a  

^a UNIVERSITY OF CHICAGO MEDICAL CENTER   (United States)

Author keywords

Analgesics; Artificial; Conscious sedation methods; Critical Illness; Humans; Hypnotics and sedatives administration and dosage; Intensive care units; Opioid administration and dosage; Respiration

Indexed keywords

17 METHYLNALTREXONE BROMIDE; ALPHA HYDROXYMIDAZOLAM; ANALGESIC AGENT; BENZODIAZEPINE DERIVATIVE; BUTYROPHENONE DERIVATIVE; CALCIUM CHANNEL BLOCKING AGENT; DEXMEDETOMIDINE; ERYTHROMYCIN; FENTANYL; HALOPERIDOL; INHALATION ANESTHETIC AGENT; ISOFLURANE; ITRACONAZOLE; LAXATIVE; LORAZEPAM; MIDAZOLAM; MORPHINE; MORPHINE 6 GLUCURONIDE; NEUROMUSCULAR BLOCKING AGENT; NORPETHIDINE; OPIATE; PETHIDINE; PROPOFOL; PROPYLENE GLYCOL; REMIFENTANIL; SEDATIVE AGENT;

ADD ON THERAPY; ADVERSE DRUG REACTION; AMNESIA; ANALGESIA; ANXIETY; AROUSAL; ARTIFICIAL VENTILATION; ASYSTOLE; BOLUS INJECTION; BRADYCARDIA; BREATHING RATE; CLINICAL PROTOCOL; CLINICAL TRIAL; CONTINUOUS INFUSION; COST CONTROL; CRITICALLY ILL PATIENT; DEEP SEDATION; DELIRIUM; DOSE RESPONSE; DRUG CHOICE; DRUG DOSE ESCALATION; DRUG DOSE REDUCTION; DRUG DOSE TITRATION; DRUG EFFECT; DRUG HALF LIFE; DRUG MEGADOSE; DRUG METABOLISM; DRUG POTENTIATION; DRUG SAFETY; DRUG WITHDRAWAL; GASTROINTESTINAL MOTILITY; HUMAN; HYPERTENSION; HYPOTENSION; ILEUS; INTENSIVE CARE UNIT; KIDNEY FAILURE; KIDNEY FUNCTION; LIPOPHILICITY; LIVER DYSFUNCTION; LOW DRUG DOSE; OUTCOME ASSESSMENT; OXYGEN CONSUMPTION; PAIN; PAIN ASSESSMENT; PATIENT ASSESSMENT; PATIENT CARE; PATIENT SELECTION; PHARMACEUTICAL CARE; PRACTICE GUIDELINE; PRIORITY JOURNAL; PROPOFOL INFUSION SYNDROME; QT PROLONGATION; RATING SCALE; RESPIRATION DEPRESSION; REVIEW; RISK FACTOR; SEDATION; SIDE EFFECT; SINGLE DRUG DOSE; TIDAL VOLUME; TORSADE DES POINTES; TREATMENT DURATION; TREATMENT INDICATION; TREATMENT OUTCOME; VENOUS RETURN; VENTILATED PATIENT; VENTILATOR ASSOCIATED PNEUMONIA;

ANALGESIA; ANALGESICS; ANXIETY; CLINICAL TRIALS AS TOPIC; CONSCIOUS SEDATION; CRITICAL CARE; HUMANS; HYPNOTICS AND SEDATIVES; INTENSIVE CARE UNITS; PAIN; PAIN MEASUREMENT; RESPIRATION, ARTIFICIAL;

EID: 58749089523     PISSN: 02725231     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ccm.2008.09.001     Document Type: Review

References (86)

1. Esteban A., Anzueto A., Frutos F., et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287 3 (2002) 345-355
2. Puntillo K.A. Pain experiences of intensive care unit patients. Heart Lung 19 5 Pt 1 (1990) 526-533
3. Turner J.S., Briggs S.J., Springhorn H.E., et al. Patient's recollection of intensive care unit experience. Crit Care Med 18 9 (1990) 966-968
4. Epstein J., and Breslow M.J. The stress response of critical illness. Crit Care Clin 15 1 (1999) 17-33
5. Lewis K.S., Whipple J.K., Michael K.A., et al. Effect of analgesic treatment on the physiologic consequences of acute pain. Am J Hosp Pharm 51 12 (1994) 1539-1554
6. Biancofiore G., Bindi M.L., Romanelli A.M., et al. Stress-inducing factors in ICUs: what liver transplant recipients experience and what caregivers perceive. Liver Transpl 11 8 (2005) 967-972
7. Novaes M.A., Knobel E., Bork A.M., et al. Stressors in ICU: perception of the patient, relatives and health care team. Intensive Care Med 27 5 (2001) 937
8. Samuelson K., Lundberg D., and Fridlund B. Memory in relation to depth of sedation in adult mechanically ventilated intensive care patients. Intensive Care Med 32 5 (2006) 660-667
9. Jones C., Griffiths R.D., Humphris G., et al. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 29 3 (2001) 573-580
10. Kress J.P., Gehlbach B., Lacy M., et al. The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med 168 12 (2003) 1457-1461
11. Schelling G., Stoll C., Haller M., et al. Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med 26 4 (1998) 651-659
12. Weinert C.R., and Sprenkle M. Post-ICU consequences of patient wakefulness and sedative exposure during mechanical ventilation. Intensive Care Med 34 1 (2008) 82-90
13. Kahn J.M., Andersson L., Karir V., et al. Low tidal volume ventilation does not increase sedation use in patients with acute lung injury. Crit Care Med 33 4 (2005) 903-904
14. Cheng I.W., Eisner M.D., Thompson B.T., et al. Acute effects of tidal volume strategy on hemodynamics, fluid balance, and sedation in acute lung injury. Crit Care Med 33 1 (2005) 239-240
15. Spina S.P., and Ensom M.H. Clinical pharmacokinetic monitoring of midazolam in critically ill patients. Pharmacology 27 3 (2007) 389-398
16. Jacobi J., Fraser G.L., Coursin D.B., et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30 1 (2002) 119-141
17. Kollef M.H., Levy N.T., Ahrens T.S., et al. The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest 114 2 (1998) 541-548
18. Rello J., Diaz E., Roque M., et al. Risk factors for developing pneumonia within 48 hours of intubation. Am J Respir Crit Care Med 159 6 (1999) 1742-1746
19. Kress J.P., Pohlman A.S., O'Connor M.F., et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342 20 (2000) 1471-1477
20. Cammarano W.B., Pittet J.F., Weitz S., et al. Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients. Crit Care Med 26 4 (1998) 676-684
21. Ely E.W., Inouye S.K., Bernard G.R., et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286 21 (2001) 2703-2710
22. Ely E.W., Margolin R., Francis J., et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 29 7 (2001) 1370-1379
23. Lin S.M., Liu C.Y., Wang C.H., et al. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 32 11 (2004) 2254-2259
24. Ely E.W., Shintani A., Truman B., et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291 14 (2004) 1753-1762
25. Pandharipande P., Shintani A., Peterson J., et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology 104 1 (2006) 21-26
26. Thomas J., Karver S., Cooney G.A., et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med 358 22 (2008) 2332-2343
27. Pasternak G.W., Bodnar R.J., Clark J.A., et al. Morphine-6-glucuronide, a potent mu agonist. Life Sci 41 26 (1987) 2845-2849
28. Goetting M., and Thirman M. Neurotoxicity of meperidine. Ann Emerg Med 14 10 (1985) 1007-1009
29. Gehlbach B.K., and Kress J.P. Sedation in the intensive care unit. Curr Opin Crit Care 8 4 (2002) 290-298
30. Westmoreland C.L., Hoke J.F., Sebel P.S., et al. Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GR90291) in patients undergoing elective surgery. Anesthesiology 79 5 (1993) 893-903
31. Muellejans B., Lopez A., Cross M.H., et al. Remifentanyl versus fentanyl for analgesia based sedation to provide patient comfort in the intensive care unit: a randomized, double-blind controlled trial. Crit Care 8 1 (2004) R1-R11
32. Dahaba A.A., Grabner T., Rehak P.H., et al. Remifentanyl versus morphine analgesia and sedation for mechanically ventilated critically ill patients: a randomized double blind study. Anesthesiology 101 3 (2004) 640-646
33. Pitsiu M., Wilmer A., Bodenham A., et al. Pharmacokinetics of remifentanil and its major metabolite, remifentanil acid, in ICU patients with renal impairment. Br J Anaesth 92 4 (2004) 493-503
34. Breen D., Wilmer A., Bodenham A., et al. Offset of pharmacodynamic effects and safety of remifentanil in intensive care unit patients with various degrees of renal impairment. Crit Care 8 1 (2004) R21-R30
35. Rhoney D.H., and Murry K.R. National survey of the use of sedating drugs, neuromuscular blocking agents and reversal agents in the intensive care unit. J Intensive Care Med 18 3 (2003) 139-145
36. Martin J., Franck M., Sigel S., et al. Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey. Crit Care 11 6 (2007) R124
37. Mehta S., Burry L., Fischer S., et al. Canadian survey of the use of sedatives, analgesics, and neuromuscular blocking agents in critically ill patients. Crit Care Med 34 2 (2006) 347-373
38. George K.A., and Dundee J.W. Relative amnesiac actions of diazepam, flunitrazepam and lorazepam in man. Br J Clin Pharmacol 4 1 (1977) 45-50
39. Gommer D., and Bakker J. Medications for analgesia and sedation in the intensive care unit: an overview. Crit Care 12 Suppl 3 (2008) S4
40. Byatt C.M., Lewis L.D., Dawling S., et al. Accumulation of midazolam after repeated dosage in patients receiving mechanical ventilation in an intensive care unit. BMJ 289 6448 (1984) 799-800
41. Tayar J., Jabbour G., and Saggi S.J. Severe hyperosmolar metabolic acidosis due to large dose of intravenous lorazepam. N Engl J Med 346 16 (2002) 1253-1254
42. Barr J., Zomorodi K., Bertaccini E.J., et al. A double-blind, randomized comparison of i.v. lorazepam versus midazolam for sedation of ICU patients via a pharmacologic model. Anesthesiology 95 2 (2001) 324-333
43. James R., and Glen J.B. Synthesis, biological evaluation and preliminary structure-activity considerations of a series of alkylphenols as intravenous anaesthetic agents. J Med Chem 23 12 (1980) 1350-1357
44. Mirenda J., and Broyles G. Propofol as used for sedation in the ICU. Chest 108 2 (1995) 539-548
45. Kress J.P., O'Connor M.F., Pohlman A.S., et al. Sedation of critically ill patients during mechanical ventilation: a comparison of propofol and midazolam. Am J Respir Crit Care Med 153 3 (1996) 1012-1018
46. Marik P.E., and Varon J. The management of status epilepticus. Chest 126 2 (2004) 582-591
47. Devlin J.W., Lau A.K., and Tanios M.A. Propofol-associated hypertriglyceridemia and pancreatitis in the intensive care unit: an analysis of frequency and risk factors. Pharmacotherapy 25 10 (2005) 1348-1352
48. Kam P.C., and Cardone D. Propofol infusion syndrome. Anaesthesia 62 7 (2007) 690-701
49. Fong J.J., Kanji S., Dasta J.F., et al. Propofol associated with a shorter duration of mechanical ventilation than scheduled intermittent lorazepam: a database analysis using Project IMPACT. Ann Pharmacother 41 12 (2007) 1986-1991
50. Carson S.S., Kress J.P., Rodgers J.E., et al. A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients. Crit Care Med 34 5 (2006) 1326-1332
51. Cox C.E., Reed S.D., Govert J.A., et al. Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation. Crit Care Med 36 3 (2008) 706-714
52. Barrientos-Vega R., Mar Sánchez-Soria M., Morales-García C., et al. Prolonged sedation of critically ill patients with midazolam or propofol: impact on weaning and costs. Crit Care Med 25 1 (1997) 33-40
53. Hall R.I., Sandham D., Cardinal P., et al. Propofol vs midazolam for ICU sedation: a Canadian multicenter randomized trial. Chest 119 4 (2001) 1151-1159
54. Glassman A.H., and Bigger Jr. J.T. Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. Am J Psychiatry 158 11 (2001) 1774-1782
55. Lawrence K.R., and Nasraway S.A. Conduction disturbances associated with administration of butyrophenone antipsychotics in the critically ill: a review of the literature. Pharmacotherapy 17 3 (1997) 531-537
56. Milbrandt E.B., Kersten A., Kong L., et al. Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients. Crit Care Med 33 1 (2005) 263-265
57. Gerlach A.T., and Dasta J.F. Dexmedetomidine: an updated review. Ann Pharmacother 41 2 (2007) 245-252
58. Martin E., Ramsay G., Mantz J., et al. The role of alpha2-adrenoreceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med 18 1 (2003) 29-41
59. Pandharipande P.P., Pun B.T., Herr D.L., et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 298 22 (2007) 2644-2653
60. Kong K.L., Willatts S.M., and Prys-Roberts C. Isoflurane compared with midazolam for sedation in the intensive care unit. BMJ 298 6683 (1989) 1277-1280
61. Millane T.A., Bennett E.D., and Grounds R.M. Isoflurane and propofol for long-term sedation in the intensive care unit. A crossover study. Anaesthesia 47 9 (1992) 768-774
62. Sackey P.V., Martling C.R., Granath F., et al. Prolonged isoflurane sedation of intensive care unit patients with the Anesthetic Conserving Device. Crit Care Med 32 11 (2004) 2241-2246
63. Breen D., Karabinis A., Malbrain M., et al. Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic based sedation for up to 10 days in intensive care unit patients: a randomized trial. Crit Care 9 3 (2005) R200-R210
64. Karabinis A., Mandragos K., Stergiopoulos S., et al. Safety and efficacy of analgesia based sedation using remifentanil versus standard hypnotic based regimens in intensive care unit patients with brain injuries; a randomized, controlled trial [ISRCTN50308308]. Crit Care 8 4 (2004) R268-R280
65. Ramsey M.A., Savege T.M., Simpson B.R., et al. Controlled sedation with alphalaxone-alphadolone. BMJ 2 5920 (1974) 256-259
66. Hansen-Flaschen J., Cowen J., and Polomano R.C. Beyond the Ramsay scale: need for a validated measure of sedating drug efficacy in the intensive care unit. Crit Care Med 22 5 (1994) 732-733
67. Riker R.R., Picard J.T., and Fraser G.L. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 27 7 (1999) 1325-1329
68. Sessler C.N., Gosnell M.S., Grap M.J., et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166 10 (2002) 1338-1344
69. Ely E.W., Truman B., Shintani A., et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation Sedation scale (RASS). JAMA 289 22 (2003) 2983-2991
70. De Jonghe B., Cook D., Griffith L., et al. Adaptation to the Intensive Care Environment (ATICE): development and validation of a new sedation assessment instrument. Crit Care Med 31 9 (2003) 2344-2354
71. Chanques G., Jaber S., Barbotte E., et al. Impact of a systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 34 6 (2006) 1691-1699
72. Payen J.F., Bru O., Bosson J.L., et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 29 12 (2001) 2258-2263
73. Hamill-Ruth R.J., and Marohn M.L. Evaluation of pain in the critically ill patient. Crit Care Clin 15 1 (1999) 35-54 v-vi
74. Sessler C.N., Grap M.J., and Brophy G.M. Multidisciplinary management of sedation and analgesia in critical care. Semin Respir Crit Care Med 22 2 (2001) 211-225
75. Riker R.R., and Fraser G.L. Monitoring sedation, agitation, analgesia, neuromuscular blockade, and delirium in adult ICU patients. Semin Respir Crit Care Med 22 2 (2001) 189-198
76. Kress J.P., and Hall J.B. Sedation in the mechanically ventilated patient. Crit Care Med 34 10 (2006) 2541-2546
77. Payen J.F., Chanques G., Mantz J., et al. Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology 106 4 (2007) 687-695
78. Brook A.D., Ahrens T.S., Schaiff R., et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27 12 (1999) 2609-2615
79. De Jonghe B., Bastuji-Garin S., Fangio P., et al. Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med 33 1 (2005) 120-127
80. Quenot J.P., Ladoire S., Devoucoux F., et al. Effect of a nurse implemented sedation protocol on the incidence of ventilator associated pneumonia. Crit Care Med 35 9 (2007) 2031-2036
81. Marshall J., Finn C.A., and Theodore A.C. Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay. Crit Care Med 36 2 (2008) 626-628
82. Bucknall T.K., Manias E., and Presneill J.J. A randomized trial of protocol-directed sedation management for mechanical ventialation in an Australian intensive care unit. Crit Care Med 36 5 (2008) 1444-1450
83. Hefner J.E. A wake-up call in the intensive care unit. N Engl J Med 342 (2000) 1520-1522
84. Kress J.P., Vinayak A.G., Levitt J., et al. Daily sedative interruption in mechanically ventilated patients at risk for coronary artery disease. Crit Care Med 35 2 (2007) 365-371
85. de Wit M., Gennings C., Jenvey W.I., et al. Randomized trial comparing daily interruption of sedation and nursing-implemented sedation algorithm in medical intensive care unit patients. Crit Care 12 3 (2008) R70
86. Girard T.D., Kress J.P., Fuchs B.D., et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomized controlled trial. Lancet 371 9607 (2008) 126-134