ICU sedation: Difference between revisions
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*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 | |||
*Decrease intracranial pressure | |||
==Agents== | ==Agents== | ||
| Line 20: | Line 18: | ||
*[[Dexmedetomidine]] | *[[Dexmedetomidine]] | ||
*[[Ketamine]] | *[[Ketamine]] | ||
*[[Haloperidol]] | *[[Haloperidol]] | ||
==Adverse Effects== | ==Adverse Effects== | ||
| Line 30: | Line 28: | ||
**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]) | ||
==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> | ||
Revision as of 20:19, 31 December 2016
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
Agents
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)
Considerations
- Lighter sedation associated with shorter ICU stay, decreased time on ventilator[1]
- Deeper sedation associated with prolonged ICU stay, increased 6 month mortality[2]
- Dexmedetomidine or propofol sedation may reduce ICU stay, time on ventilator, when compared with benzodiazepines[3]
- SCCM Recommendation, level 2B (weak recommendation)[4]
See Also
References
- ↑ 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.