Sedation critical care

Sedation in critical care units is used to reduce patient anxiety and improve tolerance to tracheal tubes and mechanical ventilation. Whenever possible, patients are sedated only to a level that allows them to open their eyes to verbal command oversedation is harmful. Commonly used drugs include propofol and midazolam, and opioids such as fentanyl, alfentanil, or morphine. 

Neuromuscular blockers are only rarely required to assist mechanical ventilation. If pain is treated properly and patient-triggered modes of ventilation are used, many patients in the critical care unit will not require sedation. Reassurance from sympathetic nursing staff is extremely important and far more effective than drugs. 

Mascia, M.F. Koch, M. Medicus, J.J. Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care. Crit. Care Med. 2000. 28 (7), 2300-2306. 

Dexmedetomidine was approved in 1999 by the FDA for the sedation of mechanically ventilated adidt patients in the critical care setting for 24 hours or less. Subsequently, it has received approval for procedural sedation in non-intubated adult patients. 

Mateu J, Barrachina F. Hypertriglyceridaemia associated with propofol sedation in critically ill patients. Intensive Care Med 1996 22(8) 834-5. 

Sandiumenge Camps A, Sanchez-Izquierdo Riera JA, Toral Vazquez D, Sa Borges M, Peinado Rodriguez J, Alted Lopez E. Midazolam and 2% propofol in longterm sedation of traumatized critically ill patients efficacy and safety comparison. Crit Care Med 2000 28(ll) 3612-9. 

Paediatrics Circadian rhythms was assessed during prolonged midazolam infusion in 27 paediatric intensive care unit children under mechanical ventilation [13 ]. This study foxmd that endogenous rhythms in critically ill and sedated children are severely disturbed and desynchronised. It also suggested that midazolam pharmacokinetics were not influenced by the light-dark cycle in children in intensive care xmits (ICUs). 

Barrientos-Vega R, Sanchez-Soiia MM, Morales-Garcia C, Robas-Gomez A, Cuena-Boy R, Ayensa-Rincon A. Prolonged sedation of critically ill patients with midazolam or propofol impact on weaning and costs. Crit Care Med 1997 25 33-40. 

---