An Update on Current Evidence for Sedation Practices in the Intensive Care Unit
Abstract
Sedation use in the intensive care unit (ICU) is an ever-changing practice. There was a time when patients on mechanical ventilation were treated with large amounts of sedative medications, leading to deep sedation where they would only respond to significant stimuli. This style of sedation is trending obsolete as increasing evidence promotes lower sedative use or no-sedation techniques. In this manuscript, we review the recent evidence regarding ICU sedation, including the use of daily sedation interruption, targeted light sedation, and no-sedation regimens to reduce sedative exposure and improve patient outcomes.
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Hughes CG, Girard TD, Pandharipande PP. Daily sedation interruption versus targeted light sedation strategies in ICU patients. Critical care medicine 2013;41:S39-45.
Porhomayon J, Nader ND, El-Solh AA, Hite M, Scott J, Silinskie K. Pre- and post-intervention study to assess the impact of a sedation protocol in critically ill surgical patients. J Surg Res 2013;184:966-U567.
Shehabi Y, Bellomo R, Reade MC, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med 2012;186:724-31.
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;166:1338-44.
Balzer F, Weiss B, Kumpf O, et al. Early deep sedation is associated with decreased in-hospital and two-year follow-up survival. Critical care 2015;19.
Barr J. Fraser GL PK, 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. Critical care medicine 2013;41:263-306.
Brattebo G, Hofoss D, Flaatten H, Muri AK, Gjerde S, Plsek PE. Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit (Reprinted from BMJ, vol 324, 1386-9, 2002). Qual Saf Health Care 2004;13:203-5.
Brook AD, Ahrens TS, Schaiff R, et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Critical care medicine 1999;27:2609-15.
Arias-Rivera S, Sanchez-Sanchez MD, Santos-Diaz R, et al. Effect of a nursing-implemented sedation protocol on weaning outcome. Critical care medicine 2008;36:2054-60.
Botha JA, Mudholkar P. The effect of a sedation scale on ventilation hours, sedative, analgesic and inotropic use in an intensive care unit. Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine 2004;6:253-7.
Kress JP, Hall JB. Daily interruption of sedative infusions in critically ill patients - Reply. New Engl J Med 2000;343:814-5.
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;371:126-34.
Nassar AP, Park M. Daily sedative interruption versus intermittent sedation in mechanically ventilated critically ill patients: a randomized trial. Ann Intensive Care 2014;4:14.
Burry L, Rose L, McCullagh IJ, Fergusson DA, Ferguson ND, Mehta S. Daily sedation interruption versus no daily sedation interruption for critically ill adult patients requiring invasive mechanical ventilation. Cochrane Db Syst Rev 2014:CD009176.
Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical care 1992;30:473-83.
Treggiari MM, Romand JA, Yanez ND, et al. Randomized trial of light versus deep sedation on mental health after critical illness. Critical care medicine 2009;37:2527-34.
Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 2010;375:475-80.
Reschreiter H, Kapila A. Ramsey sedation score. Surgery (Oxford) 2006;24:342-5.
Rozendaal FW SP, 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;35:291-8.
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]. Critical care 2005;9:R200-R10.
Karabinis A, Mandragos K, Stergiopoulos S, et al. Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial [ISRCTN50308308]. Critical care 2004;8:R268-R80.
Laerkner E, Stroem T, Toft P. No-sedation during mechanical ventilation: impact on patient's consciousness, nursing workload and costs. Nursing in critical care 2016;21:28-35.
Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. British medical journal 1974;2:656-9.
Nedergaard HK, Jensen HI, Lauridsen JT, Sjogaard G, Toft P. Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation-effects on physical function: study protocol for a randomized controlled trial: a substudy of the NONSEDA trial. Trials 2015;16:310.
Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. Jama 2012;308:1985-92.
Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. New Engl J Med 2000;342:1471-7.
Girard TD KJ, 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 controleld trial. Lancet 2008;371:126-34.
Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 1999;27:1325-9.
Barr J, Zomorodi K, Bertaccini EJ, Shafer SL, Geller E. A double-blind, randomized comparison of i.v. lorazepam versus midazolam for sedation of ICU patients via a pharmacologic model. Anesthesiology 2001;95:286-98.
Morandi A, Brummel NE, Ely EW. Sedation, delirium and mechanical ventilation: the 'ABCDE' approach. Current opinion in critical care 2011;17:43-9.
Bassett R, Adams KM, Danesh V, et al. Rethinking critical care: decreasing sedation, increasing delirium monitoring, and increasing patient mobility. Joint Commission journal on quality and patient safety / Joint Commission Resources 2015;41:62-74.
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;286:2703-10.
Dale CR, Kannas DA, Fan VS, et al. Improved analgesia, sedation, and delirium protocol associated with decreased duration of delirium and mechanical ventilation. Annals of the American Thoracic Society 2014;11:367-74.
Balas MC, Vasilevskis EE, Olsen KM, et al. Effectiveness and Safety of the Awakening and Breathing Coordination, Delirium Monitoring/Management, and Early Exercise/Mobility Bundle. Crit Care Med 2014; 42:1024-36.
DOI: http://dx.doi.org/10.18103/imr.v0i5.106
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