Sedation, analgesia, and delirium in the critically ill patient

Journal of Pharmacy Practice

Volumn 24, Issue 1, 2011, Pages 27-34

  McMillian, Wesley D ^a   Taylor, Scott ^b,c   Lat, Ishaq ^d  

^a UNIVERSITY OF VERMONT   (United States)

^b UNIVERSITY OF KANSAS   (United States)

^c UNIVERSITY OF KANSAS SCHOOL OF MEDICINE WICHITA   (United States)

^d UNIVERSITY OF CHICAGO   (United States)

Author keywords

Analgesia; Delirium; Sedation

Indexed keywords

ATYPICAL ANTIPSYCHOTIC AGENT; BENZODIAZEPINE; CHOLINERGIC RECEPTOR BLOCKING AGENT; DEXMEDETOMIDINE; DOPAMINE RECEPTOR STIMULATING AGENT; FENTANYL; FLUMAZENIL; HALOPERIDOL; HYDROMORPHONE; LORAZEPAM; METHADONE; MIDAZOLAM; MORPHINE; N METHYL DEXTRO ASPARTIC ACID RECEPTOR STIMULATING AGENT; NALOXONE; NONSTEROID ANTIINFLAMMATORY AGENT; OPIATE; PARACETAMOL; PETHIDINE; PHENANTHRENE; PROPOFOL; REMIFENTANIL;

ALPHA ADRENERGIC RECEPTOR BLOCKING; ANALGESIA; ARTICLE; CHRONIC PAIN; CLINICAL ASSESSMENT; CONTINUOUS INFUSION; CRITICALLY ILL PATIENT; DELIRIUM; DRUG CONTRAINDICATION; DRUG INDICATION; DRUG MEGADOSE; DRUG METABOLISM; HUMAN; PAIN; PATIENT MONITORING; RISK ASSESSMENT; RISK FACTOR; SEDATION; TREATMENT INDICATION;

EID: 79953905085     PISSN: 08971900     EISSN: 15311937     Source Type: Journal    
DOI: 10.1177/0897190010388139     Document Type: Article

References (75)

1. Jacobi J, Fraser GL, Coursin DB, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30(1):119-141. (Pubitemid 34112188)
2. Sessler CN, Varney K. Patient-focused sedation and analgesia in the ICU. Chest. 2008;133(2):552-565. (Pubitemid 351272418)
3. Kollef MH, Levy NT, Ahrens TS, et al. The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest. 1998;114(2):541-548. (Pubitemid 28387536)
4. Kress JP, Pohlman AS, O'Connor MF, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342(20):1471-1477. (Pubitemid 30318270)
5. Sessler CN, Grap MJ, Brophy GM. Multidisciplinary management of sedation and analgesia in critical care. Semin Respir Crit Care Med. 2001;22(2):211-226.
6. Bonney SL, Northington RS, Hedrich DA, et al. Renal safety of two analgesics used over the counter: ibuprofen and aspirin. Clin Pharmacol Ther. 1986;40(4):373-377. (Pubitemid 16009036)
7. Gelinas C, Fillion L, Puntillo KA, et al. Validation of the criticalcare pain observation tool in adult patients. Am J Crit Care. 2006;15(4):420-427. (Pubitemid 44859184)
8. Meehan DA, McRae ME, Rourke DA, et al. Analgesic administration, pain intensity, and patient satisfaction in cardiac surgical patients. Am J Crit Care. 1995;4(6):435-442.
9. Puntillo KA. Dimensions of procedural pain and its analgesic management in critically ill surgical patients. Am J Crit Care. 1994;3(2):116-122.
10. Peduta VA, Ballabio M, Stefanini S. Efficacy of propacetamol in the treatment of postoperative pain. Morphine sparing effect in orthopedic surgery. Italian Collaborative Group on Propacetamol. Acta Anaesthesiol Scand. 1998;42(3):293-298. (Pubitemid 28131377)
11. 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. 2007;11(6):R124.
12. 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. 2006;34(2):374-380. (Pubitemid 43145615)
13. Wagner BK, O'Hara DA. Pharmacokinetics and pharmacodynamics of sedatives and analgesics in the treatment of agitated critically ill patients. Clin Pharmacokinet. 1997;33(6):426-453. (Pubitemid 28014514)
14. Armstrong PJ, Bersten A. Normeperidine toxicity. Anesth Analg. 1986;65(5):536-538. (Pubitemid 16143312)
15. Remifentanil (Ultiva) [package insert]. Lake Forest, IL: Hospira, Inc; 2009.
16. Evane TN, Park GR. Remifentanil in the critically ill. Anaesthesia. 1997;52(8):800-801.
17. Delvaux B, Ryckwaert Y, Van Boven M, et al. Remifentanil in the intensive care unit: tolerance and acute withdrawal syndrome after prolonged sedation. Anesthesiology. 2005;102(6):1281-1282. (Pubitemid 40745848)
18. Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11(2 suppl):S105-S120. (Pubitemid 351682081)
19. Gaudreau JD, Gagnon P, Roy MA, et al. Opioid medications and longitudinal risk of delirium in hospitalized cancer patients. Cancer. 2007;109(11):2365- 2373. (Pubitemid 46801569)
20. Barr J, Donner A. Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit. Crit Care Clin. 1995;11(4):827-847.
21. Rhoney DH, Murry KR. National survey of the use of sedating drugs, neuromuscular blocking agents, and reversal agents in the intensive care unit. J Intensive Care Med. 2003;18(3):139-145. (Pubitemid 44544728)
22. Gehlbach BK, Kress JP. Sedation in the intensive care unit. Curr Opin Crit Care. 2002;8(4):290-298.
23. Honkus VL. Sleep deprivation in critical care units. Crit Care Nurs Q. 2003;26(3):179-189; quiz 190-191. (Pubitemid 36918022)
24. Tembo AC, Parker V. Factors that impact on sleep in intensive care patients. Intensive Crit Care Nurs. 2009;25(6):314-322.
25. Veselis RA, Reinsel RA, Feshchenko VA, et al. The comparative amnestic effects of midazolam, propofol, thiopental, and fentanyl at equisedative concentrations. Anesthesiology. 1997;87(4):749-764. (Pubitemid 27456226)
26. Jones C, Backman C, Capuzzo M, et al. Precipitants of posttraumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med. 2007; 33(6):978-985. (Pubitemid 46835399)
27. Cook DJ, Kollef MH. Risk factors for ICU-acquired pneumonia. JAMA. 1998;279(20):1605-1606. (Pubitemid 28248576)
28. Atkins PM, Mion LC, Mendelson W, et al. Characteristics and outcomes of patients who self-extubate from ventilatory support: a case-control study. Chest. 1997;112(5):1317-1323. (Pubitemid 27497866)
29. Fraser GL, Riker RR, Prato BS, et al. The frequency and cost of patient-initiated device removal in the ICU. Pharmacotherapy. 2001;21(1):1-6. (Pubitemid 32047572)
30. Ramsay MA, Savege TM, Simpson BR, et al. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2(5920):656-659.
31. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation- Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338-1344. (Pubitemid 35292699)
32. Devlin JW, Boleski G, Mlynarek M, et al. Motor Activity Assessment Scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med. 1999;27(7):1271-1275. (Pubitemid 29379363)
33. Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med. 1999;27(7):1325-1329. (Pubitemid 29379371)
34. Christensen BV, Thunedborg LP. Use of sedatives, analgesics and neuromuscular blocking agents in Danish ICUs 1996/97. A national survey. Intensive Care Med. 1999;25(2):186-191. (Pubitemid 29126845)
35. Murdoch S, Cohen A. Intensive care sedation: a review of current British practice. Intensive Care Med. 2000;26(7):922-928. (Pubitemid 30616045)
36. Patel RP, Gambrell M, Speroff T, et al. Delirium and sedation in the intensive care unit: survey of behaviors and attitudes of 1384 healthcare professionals. Crit Care Med. 2009;37(3):825-832.
37. Spina SP, Ensom MH. Clinical pharmacokinetic monitoring of midazolam in critically ill patients. Pharmacotherapy. 2007;27(3):389-398. (Pubitemid 46327906)
38. Arnold HM, Hollands JM, Skrupky LP, et al. Optimizing sustained use of sedation in mechanically ventilated patients: focus on safety. Curr Drug Saf. 2010;5(1):6-12.
39. Horinek EL, Kiser TH, Fish DN, et al. Propylene glycol accumulation in critically ill patients receiving continuous intravenous lorazepam infusions. Ann Pharmacother. 2009;43(12): 1964-1971.
40. Nelsen JL, Haas CE, Habtemariam B, et al. A prospective evaluation of propylene glycol clearance and accumulation during continuous-infusion lorazepam in critically ill patients. J Intensive Care Med. 2008;23(3):184-194. (Pubitemid 351667152)
41. Parker MG, Fraser GL, Watson DM, et al. Removal of propylene glycol and correction of increased osmolar gap by hemodialysis in a patient on high dose lorazepam infusion therapy. Intensive Care Med. 2002;28(1):81-84. (Pubitemid 34118981)
42. Yahwak JA, Riker RR, Fraser GL, et al. Determination of a lorazepamdose threshold for using the osmol gap tomonitor for propylene glycol toxicity. Pharmacotherapy. 2008;28(8):984-991.
43. Gross JB, Blouin RT, Zandsberg S, et al. Effect of flumazenil on ventilatory drive during sedation with midazolam and alfentanil. Anesthesiology. 1996;85(4):713-720. (Pubitemid 26346709)
44. Corbett SM, Moore J, Rebuck JA, et al. Survival of propofol infusion syndrome in a head-injured patient. Crit Care Med. 2006;34(9):2479-2483. (Pubitemid 44260035)
45. Otterspoor LC, Kalkman CJ, Cremer OL. Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol. 2008;21(5):544-551.
46. Bustamante SE, Appachi E. Acute pancreatitis after anesthesia with propofol in a child with glycogen storage disease type IA. Paediatr Anaesth. 2006;16(6):680-683. (Pubitemid 43806670)
47. Gottschling S, Larsen R, Meyer S, et al. Acute pancreatitis induced by short-term propofol administration. Paediatr Anaesth. 2005;15(11):1006-1008. (Pubitemid 43961320)
48. Pradeep K, Wig J, Panda NB, et al. Dose-related effect of propofol on pancreatic enzymes and triglyceride levels in patients undergoing non-abdominal surgery. Anaesth Intensive Care. 2009;37(1):27-31.
49. Aantaa R, Scheinin M. Alpha 2-adrenergic agents in anaesthesia. Acta Anaesthesiol Scand. 1993;37(5):433-448.
50. Dexmedetomidine (Precedex) [package insert]. Lake Forest, IL: Hospira, Inc; 2009.
51. Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301(5):489-499.
52. Pandharipande PP, Pun BT, HerrDL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298(22):2644-2653. (Pubitemid 350254956)
53. Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004;291(14):1753-1762. (Pubitemid 38489897)
54. Ely EW, Gautam S, Margolin R, et al. The impact of delirium in the intensive care unit on hospital length of stay. Intensive Care Med. 2001;27(12):1892-1900. (Pubitemid 33145075)
55. Lat I, McMillian W, Taylor S, et al. The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med. 2009;37(6):1898-1905.
56. Inouye SK. Delirium in older persons. N Engl J Med. 2006;354(11):1157- 1165.
57. Pandharipande P, Jackson J, Ely EW. Delirium: acute cognitive dysfunction in the critically ill. Curr Opin Crit Care. 2005;11(4): 360-368. (Pubitemid 41248311)
58. Bergeron N, Dubois MJ, Dumont M, et al. Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med. 2001;27(5):859-864. (Pubitemid 32480514)
59. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-2710. (Pubitemid 33135077)
60. Pun BT, Gordon SM, Peterson JF, et al. Large-scale implementation of sedation and deliriummonitoring in the intensive care unit: a report from two medical centers. Crit Care Med. 2005;33(6):1199-1205. (Pubitemid 40827365)
61. Gleason OC. Delirium. Am Fam Physician. 2003;67(5): 1027-1034. (Pubitemid 36301979)
62. Dubois MJ, Bergeron N, Dumont M, et al. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med. 2001;27(8):1297-1304. (Pubitemid 32758927)
63. Pandharipande P, Shintani A, Peterson J, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006;104(1):21-26.
64. Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340(9):669-676. (Pubitemid 29110750)
65. Milbrandt EB, Kersten A, Kong L, et al. Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients. Crit Care Med. 2005;33(1):226-229. discussion 63-65. (Pubitemid 40116563)
66. Devlin JW, Roberts RJ, Fong JJ, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med. 2010;38(2):419-427.
67. Girard TD, Pandharipande PP, Carson SS, et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial. Crit Care Med. 2010;38(2):428-437.
68. Hansen-Flaschen JH, Brazinsky S, Basile C, et al. Use of sedating drugs and neuromuscular blocking agents in patients requiring mechanical ventilation for respiratory failure. A national survey. JAMA. 1991;266(20):2870-2875.
69. Jacobs JR, Reves JG, Glass PS. Rationale and technique for continuous infusions in anesthesia. Int Anesthesiol Clin. 1991;29(4): 23-38.
70. Kress JP, Pohlman AS, Hall JB. Effects of sedative interruption in critically ill, mechanically ventilated patients receiving midazolam or propofol. J Clin Outcomes Manage. 2001;8(2): 33-39.
71. Kress JP, 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. 2003;168(12):1457-1461. (Pubitemid 38037329)
72. Schweickert WD, Gehlbach BK, Pohlman AS, et al. Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med. 2004;32(6): 1272-1276. (Pubitemid 38738578)
73. Girard TD, Kress JP, Fuchs BD, 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 randomised controlled trial. Lancet. 2008;371(9607):126-134.
74. Tanios MA, deWit M, Epstein SK, et al. Perceived barriers to the use of sedation protocols and daily sedation interruption: a multidisciplinary survey. J Crit Care. 2009;24(1):66-73.
75. Tablan OC, Anderson LJ, Besser R, et al. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep. 2004; 53(RR-3):1-36.