Top 10 myths regarding sedation and delirium in the ICU

Critical Care Medicine

Volumn 41, Issue 9 SUPPL.1, 2013, Pages

  Peitz, Gregory J ^a,b   Balas, Michele C ^c   Olsen, Keith M ^b   Pun, Brenda T ^d   Wesley Ely, E ^d,e  

^a UNIVERSITY OF NEBRASKA MEDICAL CENTER   (United States)

^b UNIVERSITY OF NEBRASKA MEDICAL CENTER   (United States)

^c OHIO STATE UNIVERSITY   (United States)

^d VANDERBILT UNIVERSITY MEDICAL CENTER   (United States)

^e VANDERBILT UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

agitation; analgesia; critical care medicine; delirium; evidence based; myth; pain; sedation

Indexed keywords

4 AMINOBUTYRIC ACID RECEPTOR; BENZODIAZEPINE DERIVATIVE; DEXMEDETOMIDINE; HALOPERIDOL; MIDAZOLAM; MORPHINE; PROPOFOL;

ANALGESIA; ARTICLE; ARTIFICIAL VENTILATION; BODY MOVEMENT; BRAIN BLOOD FLOW; CRITICALLY ILL PATIENT; DELIRIUM; DIAPHORESIS; EPILEPTIC STATE; EVIDENCE BASED PRACTICE; EXTUBATION; FACIAL EXPRESSION; FOLLOW UP; GLUCOSE METABOLISM; HEART MUSCLE OXYGEN CONSUMPTION; HOSPITAL DISCHARGE; HUMAN; INTENSIVE CARE UNIT; INTRACRANIAL HYPERTENSION; LONG TERM CARE; MENTAL DISEASE; MENTAL HEALTH; METABOLIC RATE; MUSCLE TONE; PAIN; PATIENT CARE; PERCEPTION; POSTTRAUMATIC STRESS DISORDER; PREVALENCE; PRIORITY JOURNAL; QUALITY OF LIFE; RISK FACTOR; SEDATION; SHORT COURSE THERAPY; SLEEP DEPRIVATION; SLEEP DISORDER; SLEEP PATTERN; TACHYCARDIA; TACHYPNEA; TERMINAL CARE; TRACHEOBRONCHIAL TOILET;

ANALGESICS; CRITICAL ILLNESS; DEEP SEDATION; DELIRIUM; EVIDENCE-BASED MEDICINE; HEALTH KNOWLEDGE, ATTITUDES, PRACTICE; HUMANS; HYPNOTICS AND SEDATIVES; INTENSIVE CARE; INTENSIVE CARE UNITS; PAIN MANAGEMENT; SLEEP; STRESS DISORDERS, POST-TRAUMATIC; UNITED STATES;

EID: 84883585708     PISSN: 00903493     EISSN: 15300293     Source Type: Journal    
DOI: 10.1097/CCM.0b013e3182a168f5     Document Type: Article

References (104)

1. 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; 342:1471-1477
2. 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; 371:126-134
3. Schweickert WD, Pohlman MC, Pohlman AS, et al: Early physical and occupational therapy in mechanically ventilated, critically ill patients: A randomised controlled trial. Lancet 2009; 373:1874-1882
4. 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; 27:1892-1900
5. 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; 291:1753-1762
6. Milbrandt EB, Deppen S, Harrison PL, et al: Costs associated with delirium in mechanically ventilated patients. Crit Care Med 2004; 32:955-962
7. Spronk PE, Riekerk B, Hofhuis J, et al: Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med 2009; 35:1276-1280
8. Barr J, Fraser GL, Puntillo K, et al; American College of Critical Care Medicine: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013; 41:263-306
9. Weinert C, McFarland L: The state of intubated ICU patients: Development of a two-dimensional sedation rating scale for critically ill adults. Chest 2004; 126:1883-1890
10. Rotondi AJ, Chelluri L, Sirio C, et al: Patients' recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med 2002; 30:746-752
11. Jones C, Bäckman C, Capuzzo M, et al: Precipitants of post-traumatic stress disorder following intensive care: A hypothesis generating study of diversity in care. Intensive Care Med 2007; 33:978-985
12. Riker RR, Shehabi Y, Bokesch PM, et al; SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group: Dexmedetomidine vs midazolam for sedation of critically ill patients: A randomized trial. JAMA 2009; 301:489-499
13. Fraser GL, Devlin JW, Worby CP, et al: Benzodiazepine Versus Nonbenzodiazepine-Based Sedation for Mechanically Ventilated, Critically Ill Adults: A Systematic Review and Meta-Analysis of Randomized Trials. Crit Care Med 2013; 41(Suppl):S30-S38
14. Wade DM, Howell DC, Weinman JA, et al: Investigating risk factors for psychological morbidity three months after intensive care: A prospective cohort study. Crit Care 2012; 16:R192
15. Strøm T, Martinussen T, Toft P: A protocol of no sedation for critically ill patients receiving mechanical ventilation: A randomised trial. Lancet 2010; 375:475-480
16. 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 randomised trial [ISRCTN47583497]. Crit Care 2005; 9:R200-R210
17. Rozendaal FW, Spronk PE, Snellen FF, et al; UltiSAFE investigators: Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: A centre randomised, cross-over, open-label study in the Netherlands. Intensive Care Med 2009; 35:291-298
18. Guttormson JL, Chlan L, Weinert C, et al: Factors influencing nurse sedation practices with mechanically ventilated patients: A U.S. national survey. Intensive Crit Care Nurs 2010; 26:44-50
19. Wunsch H, Kahn JM, Kramer AA, et al: Use of intravenous infusion sedation among mechanically ventilated patients in the United States. Crit Care Med 2009; 37:3031-3039
20. Shehabi Y, Bellomo R, Reade MC, et al; Sedation Practice in Intensive Care Evaluation (SPICE) Study Investigators; ANZICS Clinical Trials Group: Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med 2012; 186:724-731
21. Shehabi Y, Chan L, Kadiman S, et al; Sedation Practice in Intensive Care Evaluation (SPICE) Study Group investigators: Sedation depth and long-term mortality in mechanically ventilated critically ill adults: A prospective longitudinal multicentre cohort study. Intensive Care Med 2013; 39:910-918
22. Hager DN, Dinglas VD, Subhas S, et al: Reducing deep sedation and delirium in acute lung injury patients: A quality improvement project. Crit Care Med 2013; 41:1435-1442
23. Devabhakthuni S, Armahizer MJ, Dasta JF, et al: Analgosedation: A paradigm shift in intensive care unit sedation practice. Ann Pharmacother 2012; 46:530-540
24. Schweickert WD, Kress JP: Strategies to optimize analgesia and sedation. Crit Care 2008; 12(Suppl 3):S6
25. Lindenbaum L, Milia DJ: Pain management in the ICU. Surg Clin North Am 2012; 92:1621-1636
26. Puntillo KA, Arai S, Cohen NH, et al: Symptoms experienced by intensive care unit patients at high risk of dying. Crit Care Med 2010; 38:2155-2160
27. Jeitziner MM, Schwendimann R, Hamers JP, et al: Assessment of pain in sedated and mechanically ventilated patients: An observational study. Acta Anaesthesiol Scand 2012; 56:645-654
28. Erstad BL, Puntillo K, Gilbert HC, et al: Pain management principles in the critically ill. Chest 2009; 135:1075-1086
29. Payen JF, 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 2007; 106:687-695; quiz 891-892
30. Payen JF, Bosson JL, Chanques G, et al; DOLOREA Investigators: Pain assessment is associated with decreased duration of mechanical ventilation in the intensive care unit: A post hoc analysis of the DOLOREA study. Anesthesiology 2009; 111:1308-1316
31. Ethier C, Burry L, Martinez-Motta C, et al; Canadian Critical Care Trials Group: Recall of intensive care unit stay in patients managed with a sedation protocol or a sedation protocol with daily sedative interruption: A pilot study. J Crit Care 2011; 26:127-132
32. Granja C, Gomes E, Amaro A, et al; JMIP Study Group: Understanding posttraumatic stress disorder-related symptoms after critical care: The early illness amnesia hypothesis. Crit Care Med 2008; 36:2801-2809
33. 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 1998; 26:651-659
34. Hardin KA: Sleep in the ICU: Potential mechanisms and clinical implications. Chest 2009; 136:284-294
35. Weinhouse GL, Watson PL: Sedation and sleep disturbances in the ICU. Crit Care Clin 2009; 25:539-549
36. Jacobi J, Fraser GL, Coursin DB, et al; Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), American Society of Health-System Pharmacists (ASHP), American College of Chest Physicians: Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30:119-141
37. Boyko Y, Ording H, Jennum P: Sleep disturbances in critically ill patients in ICU: How much do we know? Acta Anaesthesiol Scand 2012; 56:950-958
38. Devlin JW, Roberts RJ: Pharmacology of commonly used analgesics and sedatives in the ICU: Benzodiazepines, propofol, and opioids. Crit Care Clin 2009; 25:431-449
39. Alkire MT, Haier RJ, Barker SJ, et al: Cerebral metabolism during propofol anesthesia in humans studied with positron emission tomography. Anesthesiology 1995; 82:393-403
40. Weinhouse GL: Pharmacology I: Effects on sleep of commonly used ICU medications. Crit Care Clin 2008; 24:477-491
41. Patel M, Chipman J, Carlin BW, et al: Sleep in the intensive care unit setting. Crit Care Nurs Q 2008; 31:309-318
42. Bihari S, Doug McEvoy R, Matheson E, et al: Factors affecting sleep quality of patients in intensive care unit. J Clin Sleep Med 2012; 8:301-307
43. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington, DC, American Psychiatric Association, 2000
44. Ely EW, Stephens RK, Jackson JC, et al: Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: A survey of 912 healthcare professionals. Crit Care Med 2004; 32:106-112
45. Ely EW, Siegel MD, Inouye SK: Delirium in the intensive care unit: An under-recognized syndrome of organ dysfunction. Semin Respir Crit Care Med 2001; 22:115-126
46. Ouimet S, Kavanagh BP, Gottfried SB, et al: Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007; 33:66-73
47. Ely EW, 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 2001; 29:1370-1379
48. Pisani MA, Kong SY, Kasl SV, et al: Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 2009; 180:1092-1097
49. Girard TD, Jackson JC, Pandharipande PP, et al: Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010; 38:1513-1520
50. Misak C: ICU psychosis and patient autonomy: Some thoughts from the inside. J Med Philos 2005; 30:411-430
51. Pun BT, Gordon SM, Peterson JF, et al: Large-scale implementation of sedation and delirium monitoring in the intensive care unit: A report from two medical centers. Crit Care Med 2005; 33:1199-1205
52. Devlin JW, Fong JJ, Schumaker G, et al: Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients. Crit Care Med 2007; 35:2721-2724; quiz 2725
53. Devlin JW, Fong JJ, Howard EP, et al: Assessment of delirium in the intensive care unit: Nursing practices and perceptions. Am J Crit Care 2008; 17:555-565
54. 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; 286:2703-2710
55. Bergeron N, Dubois MJ, Dumont M, et al: Intensive Care Delirium Screening Checklist: Evaluation of a new screening tool. Intensive Care Med 2001; 27:859-864
56. 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; 104:21-26
57. Pandharipande PP, Pun BT, Herr DL, et al: Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: The MENDS randomized controlled trial. JAMA 2007; 298:2644-2653
58. Salluh JI, Dal-Pizzol F, Mello PV, et al; Brazilian Research in Intensive Care Network: Delirium recognition and sedation practices in critically ill patients: A survey on the attitudes of 1015 Brazilian critical care physicians. J Crit Care 2009; 24:556-562
59. 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; 37:825-832
60. Plaschke K, von Haken R, Scholz M, et al: Comparison of the confusion assessment method for the intensive care unit (CAM-ICU) with the Intensive Care Delirium Screening Checklist (ICDSC) for delirium in critical care patients gives high agreement rate(s). Intensive Care Med 2008; 34:431-436
61. Gesin G, Russell BB, Lin AP, et al: Impact of a delirium screening tool and multifaceted education on nurses' knowledge of delirium and ability to evaluate it correctly. Am J Crit Care 2012; 21:e1-e11
62. Soja SL, Pandharipande PP, Fleming SB, et al: Implementation, reliability testing, and compliance monitoring of the Confusion Assessment Method for the Intensive Care Unit in trauma patients. Intensive Care Med 2008; 34:1263-1268
63. Vasilevskis EE, Morandi A, Boehm L, et al: Delirium and sedation recognition using validated instruments: Reliability of bedside intensive care unit nursing assessments from 2007 to 2010. J Am Geriatr Soc 2011; 59(Suppl 2):S249-S255
64. Devlin JW, Marquis F, Riker RR, et al: Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside. Crit Care 2008; 12:R19
65. Vasilevskis EE, Ely EW, Speroff T, et al: Reducing iatrogenic risks: ICU-acquired delirium and weakness-Crossing the quality chasm. Chest 2010; 138:1224-1233
66. Lin SM, Huang CD, Liu CY, et al: Risk factors for the development of early-onset delirium and the subsequent clinical outcome in mechanically ventilated patients. J Crit Care 2008; 23:372-379
67. Peterson JF, Pun BT, Dittus RS, et al: Delirium and its motoric subtypes: A study of 614 critically ill patients. J Am Geriatr Soc 2006; 54:479-484
68. Devlin JW, Bhat S, Roberts RJ, et al: Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: A survey of 250 critical care pharmacists from eight states. Ann Pharmacother 2011; 45:1217-1229
69. Hipp DM, Ely EW: Pharmacological and nonpharmacological management of delirium in critically ill patients. Neurotherapeutics 2012; 9:158-175
70. van den Boogaard M, Pickkers P, van der Hoeven H, et al: Implementation of a delirium assessment tool in the ICU can influence haloperidol use. Crit Care 2009; 13:R131
71. Wang W, Li HL, Wang DX, et al: Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: A randomized controlled trial. Crit Care Med 2012; 40:731-739
72. van den Boogaard M, Schoonhoven L, van Achterberg T, et al: Haloperidol prophylaxis in critically ill patients with a high risk for delirium. Crit Care 2013; 17:R9
73. 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; 38:419-427
74. Skrobik YK, Bergeron N, Dumont M, et al: Olanzapine vs haloperidol: Treating delirium in a critical care setting. Intensive Care Med 2004; 30:444-449
75. Pandharipande PP, Sanders RD, Girard TD, et al; MENDS investigators: Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: An a priori-designed analysis of the MENDS randomized controlled trial. Crit Care 2010; 14:R38
76. Awissi DK, Lebrun G, Coursin DB, et al: Alcohol withdrawal and delirium tremens in the critically ill: A systematic review and commentary. Intensive Care Med 2013; 39:16-30
77. Carrasco G, Cabré L, Sobrepere G, et al: Synergistic sedation with propofol and midazolam in intensive care patients after coronary artery bypass grafting. Crit Care Med 1998; 26:844-851
78. Mehta S, McCullagh I, Burry L: Current sedation practices: Lessons learned from international surveys. Anesthesiol Clin 2011; 29:607-624
79. Kollef MH, Levy NT, Ahrens TS, et al: The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest 1998; 114:541-548
80. Walker N, Gillen P: Investigating nurses' perceptions of their role in managing sedation in intensive care: An exploratory study. Intensive Crit Care Nurs 2006; 22:338-345
81. Roberts RJ, de Wit M, Epstein SK, et al: Predictors for daily interruption of sedation therapy by nurses: A prospective, multicenter study. J Crit Care 2010; 25:660.e1-660.e7
82. Tanios MA, de Wit M, Epstein SK, et al: Perceived barriers to the use of sedation protocols and daily sedation interruption: A multidisciplinary survey. J Crit Care 2009; 24:66-73
83. Kress JP, Vinayak AG, Levitt J, et al: Daily sedative interruption in mechanically ventilated patients at risk for coronary artery disease. Crit Care Med 2007; 35:365-371
84. 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; 168:1457-1461
85. Jackson JC, Girard TD, Gordon SM, et al: Long-term cognitive and psychological outcomes in the awakening and breathing controlled trial. Am J Respir Crit Care Med 2010; 182:183-191
86. Mehta S, Burry L, Cook D, et al; SLEAP Investigators; Canadian Critical Care Trials Group: Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: A randomized controlled trial. JAMA 2012; 308:1985-1992
87. McCollam JS, O'Neil MG, Norcross ED, et al: Continuous infusions of lorazepam, midazolam, and propofol for sedation of the critically ill surgery trauma patient: A prospective, randomized comparison. Crit Care Med 1999; 27:2454-2458
88. Barr J, Zomorodi K, Bertaccini EJ, et al: A double-blind, randomized comparison of i.v. lorazepam versus midazolam for sedation of ICU patients via a pharmacologic model. Anesthesiology 2001; 95:286-298
89. Barr J, Egan TD, Sandoval NF, et al: Propofol dosing regimens for ICU sedation based upon an integrated pharmacokinetic-pharmacodynamic model. Anesthesiology 2001; 95:324-333
90. Iirola T, Ihmsen H, Laitio R, et al: Population pharmacokinetics of dexmedetomidine during long-term sedation in intensive care patients. Br J Anaesth 2012; 108:460-468
91. Shelly MP, Mendel L, Park GR: Failure of critically ill patients to metabolise midazolam. Anaesthesia 1987; 42:619-626
92. Bauer TM, Ritz R, Haberthür C, et al: Prolonged sedation due to accumulation of conjugated metabolites of midazolam. Lancet 1995; 346:145-147
93. Hill L, Bertaccini E, Barr J, et al: ICU sedation: A review of its pharmacology and assessment. J Intensive Care Med 1998; 13:174-183
94. Desai SV, Law TJ, Needham DM: Long-term complications of critical care. Crit Care Med 2011; 39:371-379
95. Adamis D, Dimitriou C, Anifantaki S, et al: Validation of the Greek version of confusion assessment method for the intensive care unit (CAM-ICU). Intensive Crit Care Nurs 2012; 28:337-343
96. Jackson JC, Hart RP, Gordon SM, et al: Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: Assessing the magnitude of the problem. Crit Care 2007; 11:R27
97. Griffiths J, Fortune G, Barber V, et al: The prevalence of post traumatic stress disorder in survivors of ICU treatment: A systematic review. Intensive Care Med 2007; 33:1506-1518
98. Davydow DS, Gifford JM, Desai SV, et al: Posttraumatic stress disorder in general intensive care unit survivors: A systematic review. Gen Hosp Psychiatry 2008; 30:421-434
99. Heffner JE: A wake-up call in the intensive care unit. N Engl J Med 2000; 342:1520-1522
100. Brochard L: Sedation in the intensive-care unit: Good and bad? Lancet 2008; 371:95-97
101. Girard TD, Shintani AK, Jackson JC, et al: Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: A prospective cohort study. Crit Care 2007; 11:R28
102. Jones C, Griffiths RD, Humphris G, et al: Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 2001; 29:573-580
103. Treggiari MM, Romand JA, Yanez ND, et al: Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med 2009; 37:2527-2534
104. Duhigg C: The Power of Habit-Why We Do What We Do in Life and Business. New York: Random House; 2012