National analysis of applied sedation in critical care patients
DOI:
https://doi.org/10.56294/saludcyt2022234Keywords:
Intensive Care Units, Propofol, Midazolam, Dexmedetomidine, SevofluraneAbstract
Introduction: within the Intensive Care Unit, procedures such as sedation are performed in order to provide relaxation to the patient, for the use of sedatives parameters such as medical prescription, patient condition, type of sedation, adverse effects, etc. will be taken into account.
Objective: analyze the use of sedative drugs in critically ill patients from a national to international perspective.
Methods: a descriptive and qualitative study was carried out, through a meticulous bibliographic search of the last 5 years, finally 35 articles were obtained in different databases such as Pudmed, Elsevier, SciELO, Wiley and Scopus.
Results: among the main results, both national and international perspectives were found about the most frequently used sedatives in the intensive care service.
Conclusions: it was found that the sedatives with the highest risk of delirium are Benzodiazepines compared to Propofol, in turn the first-line sedative used in the Intensive Care Unit is dexmedetomidine.
References
1. Kermad A, Speltz J, Danziger G, Mertke T, Bals R, Volk T, et al. Comparison of isoflurane and propofol sedation in critically ill COVID ‑ 19 patients — a retrospective chart review. J Anesth. 2021;35(5):625-32. https://doi.org/10.1007%2Fs00540-021-02960-6
2. Carrillo-Esper R, Velarde PAA, Zepeda MAD, et al. Documento de posicionamiento: uso de sedación inhalada en el paciente críticamente enfermo. Med Crit. 2022;36(Suppl: 2):s43-64. http://doi.org/10.35366/107394.
3. Talsi O, Berggren RK. A national survey on routines regarding sedation in Swedish intensive care units. Ups J Med Sci. 2019;124(3):199-202. https://doi.org/10.1080%2F03009734.2019.1616339
4. Olmos M, Varela D, Klein F. Enfoque actual de la analgesia, sedación y el delirium en Cuidados Críticos. Revista Médica Clínica Las Condes 2019;30:126–39. https://doi.org/10.1016/j.rmclc.2019.03.002.
5. Blondonnet R, Quinson A, Lambert C, Audard J, Godet T, Zhai R, et al. Use of volatile agents for sedation in the intensive care unit: A national survey in France. PLoS One 2021;16:e0249889. https://doi.org/10.1371/journal.pone.0249889.
6. Bailly P, Egreteau P-Y, Ehrmann S, Thille AW, Guitton C, Grillet G, et al. Inased (inhaled sedation in ICU) trial protocol: a multicentre randomised open-label trial. BMJ Open 2021;11:e042284. https://doi.org/10.1136/bmjopen-2020-042284.
7. Polo Morís B, González Fernández A, González Fernández C. Papel de la enfermería en la sedoanalgesia del paciente crítico. NPunto 2019;2:3.
8. Herzog-Niescery J, Seipp H-M, Weber TP, Bellgardt M. Inhaled anesthetic agent sedation in the ICU and trace gas concentrations: a review. J Clin Monit Comput 2018;32:667–75. https://doi.org/10.1007/s10877-017-0055-6.
9. Ramírez García HA, Cerda Arteaga JM, Chávez Pérez C, Sánchez Nava VM, Ramírez García HA, Cerda Arteaga JM, et al. Sedación con sistema AnaConDa en pacientes COVID-19 crítico y su impacto en días de ventilación mecánica. Medicina crítica (Colegio Mexicano de Medicina Crítica) 2022;36:138–41. https://doi.org/10.35366/105378
10. Chen T-J, Chung Y-W, Chen P-Y, Hu SH, Chang C-C, Hsieh S-H, et al. Effects of daily sedation interruption in intensive care unit patients undergoing mechanical ventilation: A meta-analysis of randomized controlled trials. International Journal of Nursing Practice 2022;28:e12948. https://doi.org/10.1111/ijn.12948
11. Deng P, Hao L, Deng Y, Yao R, Cao Y. Pre-emptive remifentanil alleviates pain associated with tracheal suctioning in patients under mechanical ventilation and goal-directed sedation: A randomized controlled feasibility trial. International Journal of Nursing Practice 2022;28:e12915. https://doi.org/10.1111/ijn.12915.
12. Mahmoud L, Zullo AR, Thompson BB, Wendell LC, Mahmoud L, Zullo AR, et al. Outcomes of protocolised analgesia and sedation in a neurocritical care unit. Brain Injury. 2018;32(7):941-947. https://doi.org/10.1080/02699052.2018.1469167.
13. Bellgardt M, Georgevici AI, Klutzny M, Drees D, Meiser A, Gude P, et al. Use of MIRUS™ for MAC-driven application of isoflurane, sevoflurane, and desflurane in postoperative ICU patients: a randomized controlled trial. Ann Intensive Care 2019;9:118. https://doi.org/10.1186/s13613-019-0594-8.
14. Flinspach AN, Herrmann E, Raimann FJ, Zacharowski K, Adam EH. Evaluation of volatile sedation in the postoperative intensive care of patients recovering from heart valve surgery: protocol for a randomised, controlled, monocentre trial. BMJ Open 2022;12:e057804. https://doi.org/10.1136/bmjopen-2021-057804
15. Daume P, Weis J, Bomberg H, Bellgardt M, Volk T, Groesdonk HV, et al. Washout and Awakening Times after Inhaled Sedation of Critically Ill Patients: Desflurane Versus Isoflurane. Journal of Clinical Medicine 2021;10:665. https://doi.org/10.3390/jcm10040665.
16. Choi H-R, Song I-A. Review of remimazolam and sedatives in the intensive care unit. ACC 2022;37:151–8. https://doi.org/10.4266/acc.2022.00619.
17. Driscoll CAH, Davis NL, Miles M, El-Metwally D. A Quality Improvement Project to Improve Evidence-Based Inhaled Nitric Oxide Use. Respiratory Care 2018;63:20–7. https://doi.org/10.4187/respcare.05619.
18. Barr J, Egan TD, Sandoval NF, Zomorodi K, Cohane C, Gambus PL, et al. Propofol Dosing Regimens for ICU Sedation Based upon an Integrated Pharmacokinetic– Pharmacodynamic Model. Anesthesiology 2001;95:324–33. https://doi.org/10.1097/00000542-200108000-00011.
19. Donato M, Carini FC, Meschini MJ, Saubidet IL, Goldberg A, Sarubio MG, et al. Consenso para el manejo de la analgesia, sedación y delirium en adultos con síndrome de distrés respiratorio agudo por COVID-19. Rev bras ter intensiva 2021;33:48–67. https://doi.org/10.5935/0103-507X.20210005.
20. Liu Y, Yu X, Zhu D, Zeng J, Lin Q, Zang B, et al. Safety and efficacy of ciprofol vs. propofol for sedation in intensive care unit patients with mechanical ventilation: a multi-center, open label, randomized, phase 2 trial. Chinese Medical Journal 2022;135:1043. https://doi.org/10.1097/CM9.0000000000001912.
21. Krishna B. Inhaled Anesthetics for Sedation in ICU: Widening Horizons! Indian J Crit Care Med 2022;26:889–91. https://doi.org/10.5005/jp-journals-10071-24295.
22. Scherer C, Kleeberger J, Kellnar A, Binzenhöfer L, Lüsebrink E, Stocker TJ, et al. Propofol versus midazolam sedation in patients with cardiogenic shock - an observational propensity-matched study. Journal of Critical Care 2022;71:154051. https://doi.org/10.1016/j.jcrc.2022.154051.
23. Romagnoli S, Amigoni A, Blangetti I, Casella G, Chelazzi C, Forfori F, et al. Light sedation with dexmedetomidine: a practical approach for the intensivist in different ICU patients. Minerva Anestesiol 2018;84:731–46. https://doi.org/10.23736/S0375-9393.18.12350-9
24. Kydonaki K, Hanley J, Huby G, Antonelli J, Walsh TS. Challenges and barriers to optimising sedation in intensive care: a qualitative study in eight Scottish intensive care units. BMJ Open 2019;9:e024549. https://doi.org/10.1136/bmjopen-2018-024549.
25. Wąsowicz M, Jerath A, Luksun W, Sharma V, Mitsakakis N, Meineri M, et al. Comparison of propofol-based versus volatile-based anaesthesia and postoperative sedation in cardiac surgical patients: a prospective, randomized, study. Anaesthesiol Intensive Ther 2018;50:200–9. https://doi.org/10.5603/AIT.a2018.0012.
26. Jung S, Na S, Kim HB, Joo HJ, Kim J. Inhalation sedation for postoperative patients in the intensive care unit: initial sevoflurane concentration and comparison of opioid use with propofol sedation. Acute Crit Care 2020;35:197–204. https://doi.org/10.4266/acc.2020.00213.
27. Liu J, Wang Y, Ma W. Shivering prevention and treatment during cesarean delivery under neuraxial anesthesia: a systematic review. Minerva Anestesiol 2018;84:1393–405. https://doi.org/10.23736/S0375-9393.18.12478-3.
28. Smuszkiewicz P, Wiczling P, Ber J, Warzybok J, Małkiewicz T, Matysiak J, et al. Pharmacokinetics of dexmedetomidine during analgosedation in ICU patients. J Pharmacokinet Pharmacodyn 2018;45:277–84. https://doi.org/10.1007/s10928-017-9564-7.
29. Su L, Liu C, Chang F, Tang B, Han L, Jiang H, et al. Selection strategy for sedation depth in critically ill patients on mechanical ventilation. BMC Medical Informatics and Decision Making 2021;21:79. https://doi.org/10.1186/s12911-021-01452-7.
30. Sun R, Wang S, Li S, Yang C, Zhao Y, Luo A. Effects of dexmedetomidine on delirium and mortality during sedation in ICU patients: a systematic review and meta-analysis protocol. BMJ Open 2019;9:e025850. https://doi.org/10.1136/bmjopen-2018-025850.
31. Vagionas D, Vasileiadis I, Rovina N, Alevrakis E, Koutsoukou A, Koulouris N. Daily sedation interruption and mechanical ventilation weaning: a literature review. Anaesthesiol Intensive Ther 2019;51:380–9. https://doi.org/10.5114/ait.2019.90921.
32. Wong IMJ, Thangavelautham S, Loh SCH, Ng SY, Murfin B, Shehabi Y. Sedation and Delirium in the Intensive Care Unit-A Practice-Based Approach. Ann Acad Med Singap 2020;49:215–25.
33. Olsen HT, Nedergaard HK, Strøm T, Oxlund J, Wian K-A, Ytrebø LM, et al. Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients. New England Journal of Medicine 2020;382:1103–11. https://doi.org/10.1056/NEJMoa1906759.
34. Kamphausen A, Roese H, Oechsle K, Issleib M, Zöllner C, Bokemeyer C, et al. Challenges Faced by Prehospital Emergency Physicians Providing Emergency Care to Patients with Advanced Incurable Diseases. Emerg Med Int 2019;2019:3456471. https://doi.org/10.1155/2019/3456471.
35. Pujol J, Martínez-Vilavella G, Gallart L, Blanco-Hinojo L, Pacreu S, Bonhomme V, et al. Effects of remifentanil on brain responses to noxious stimuli during deep propofol sedation. British Journal of Anaesthesia 2023;130:e330–8. https://doi.org/10.1016/j.bja.2022.06.038
Published
Issue
Section
License
Copyright (c) 2022 Grace Pamela López Pérez , Melani Dayana Carrera Casa , Gissela Lizbeth Amancha Moyulema , Yadira Nathaly Chicaiza Quilligana , Ana Belén Guamán Tacuri , Joselyn Mireya Iza Arias (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.
