OBJECTIVE: To critically evaluate the use of analgosedation in the management of agitation in critically ill mechanically ventilated patients. DATA SOURCES: Literature was accessed through MEDLINE (1948-November 2011) and Cochrane Library (2011, issue 1) using the terms analgosedation, analgosedation, or analgesia-based sedation alone or in combination with intensive care unit or critically ill. Reference lists of related publications were also reviewed. STUDY SELECTION AND DATA EXTRACTION: All articles published in English were evaluated. Randomized controlled trials examining critically ill mechanically ventilated patients older than 18 years were included. DATA SYNTHESIS: Limitations of current sedation practices include serious adverse drug events, prolonged mechanical ventilation time, and intensive care unit (ICU) length of stay. Studies have demonstrated that analgosedation, a strategy that manages patient pain and discomfort first, before providing sedative therapy, results in improved patient outcomes compared to standard sedative-hypnotic regimens. Nine randomized controlled trials comparing remifentanil-based analgosedation to other commonly used agents (fentanyl, midazolam, morphine, and propofol) for ICU sedation and 1 trial comparing morphine to daily sedation interruption with propofol or midazolam were reviewed. Remifentanil is an ideal agent for analgosedation due to its easy titratability and organ-independent metabolism. When compared to sedative-hypnotic regimens, remifentanil-based regimens were associated with shorter duration of mechanical ventilation, more rapid weaning from the ventilator, and shorter ICU length of stay. Compared to fentanyl-based regimens, remifentanil had similar efficacy with the exception of increased pain requirements upon remifentanil discontinuation. Analgosedation was well tolerated, with no significant differences in hemodynamic stability compared to sedative-hypnotic regimens. CONCLUSIONS: Analgosedation is an efficacious and well-tolerated approach to management of ICU sedation with improved patient outcomes compared to sedative-hypnotic approaches. Additional well-designed trials are warranted to clarify the role of analgosedation in the management of ICU sedation, including trials with nonopioid analgesics.
OBJECTIVE: To critically evaluate the use of analgosedation in the management of agitation in critically ill mechanically ventilated patients. DATA SOURCES: Literature was accessed through MEDLINE (1948-November 2011) and Cochrane Library (2011, issue 1) using the terms analgosedation, analgosedation, or analgesia-based sedation alone or in combination with intensive care unit or critically ill. Reference lists of related publications were also reviewed. STUDY SELECTION AND DATA EXTRACTION: All articles published in English were evaluated. Randomized controlled trials examining critically ill mechanically ventilated patients older than 18 years were included. DATA SYNTHESIS: Limitations of current sedation practices include serious adverse drug events, prolonged mechanical ventilation time, and intensive care unit (ICU) length of stay. Studies have demonstrated that analgosedation, a strategy that manages patientpain and discomfort first, before providing sedative therapy, results in improved patient outcomes compared to standard sedative-hypnotic regimens. Nine randomized controlled trials comparing remifentanil-based analgosedation to other commonly used agents (fentanyl, midazolam, morphine, and propofol) for ICU sedation and 1 trial comparing morphine to daily sedation interruption with propofol or midazolam were reviewed. Remifentanil is an ideal agent for analgosedation due to its easy titratability and organ-independent metabolism. When compared to sedative-hypnotic regimens, remifentanil-based regimens were associated with shorter duration of mechanical ventilation, more rapid weaning from the ventilator, and shorter ICU length of stay. Compared to fentanyl-based regimens, remifentanil had similar efficacy with the exception of increased pain requirements upon remifentanil discontinuation. Analgosedation was well tolerated, with no significant differences in hemodynamic stability compared to sedative-hypnotic regimens. CONCLUSIONS: Analgosedation is an efficacious and well-tolerated approach to management of ICU sedation with improved patient outcomes compared to sedative-hypnotic approaches. Additional well-designed trials are warranted to clarify the role of analgosedation in the management of ICU sedation, including trials with nonopioid analgesics.
Authors: Rick Bassett; Kelly McCutcheon Adams; Valerie Danesh; Patricia M Groat; Angie Haugen; Angi Kiewel; Cora Small; Mark Van-Leuven; Sam Venus; E Wesley Ely Journal: Jt Comm J Qual Patient Saf Date: 2015-02
Authors: Andrew C Faust; Pearl Rajan; Lyndsay A Sheperd; Carlos A Alvarez; Phyllis McCorstin; Rebecca L Doebele Journal: Anesth Analg Date: 2016-10 Impact factor: 5.108
Authors: Tan Seng Beng; Carol Lai Cheng Kim; Chai Chee Shee; Diana Ng Leh Ching; Tan Jiunn Liang; Mehul Kumar Narendra Kumar; Ng Chong Guan; Lim Poh Khuen; Lam Chee Loong; Loh Ee Chin; Sheriza Izwa Zainuddin; David Paul Capelle; Ang Chui Munn; Lim Kah Yen; Nik Nathasha Hani Nik Isahak Journal: Am J Hosp Palliat Care Date: 2021-09-16 Impact factor: 2.090