Published in:
01-03-2014 | Year in Review 2013
Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients
Authors:
Elie Azoulay, Giuseppe Citerio, Jan Bakker, Matteo Bassetti, Dominique Benoit, Maurizio Cecconi, J. Randall Curtis, Glenn Hernandez, Margaret Herridge, Samir Jaber, Michael Joannidis, Laurent Papazian, Mark Peters, Pierre Singer, Martin Smith, Marcio Soares, Antoni Torres, Antoine Vieillard-Baron, Jean-François Timsit
Published in:
Intensive Care Medicine
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Issue 3/2014
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Excerpt
Intensive Care Medicine has taken part this year in the ongoing controversy about sedation strategies for the critically ill. Shehabi et al. [
1] replicated the ANZ SPICE study design in 11 Malaysian ICUs to assess whether early sedation depth was independently associated with delayed extubation and increased mortality. They performed a prospective multicenter study that included 259 medical/surgical patients who were sedated and ventilated for at least 24 h. Deep sedation, defined as Richmond Agitation Sedation Score (RASS) ≤ −3, occurred in 71 % of patients at first assessment. Multivariable Cox proportional hazard regression analysis adjusting for confounders confirmed that early deep sedation was independently associated with longer time to extubation, hospital and 180-day mortality. Delirium occurred in 114 (44 %) of patients but was not associated with sedation length upon first assessment. The performance and the feasibility of an automated administration of sedation were evaluated in a phase II randomized controlled trial (RCT) by Le Guen et al. [
2]. Thirty-one patients were allocated to receive either propofol or remifentanil, through either an automated or a manual system. In the two groups, targeted bispectral index (BIS) values were between 40 and 60. Propofol consumption was reduced by 50 % in the automated group with a median change of infusion rates of 39 ± 9 times per hour compared to only 2 ± 1 propofol dose changes per hour in the manual group. Similarly, the median number of changes in infusion rates was 40 ± 9 for remifentanil in the automated group, compared to 1 ± 1 dose changes per hour in the manual group. In a single-center pilot study of critically ill patients in spontaneous ventilation undergoing flexible fiberoptic bronchoscopy, the safety and efficacy of sedation with remifentanil target-controlled infusion (Remi-TCI) were assessed by Chalumeau-Lemoine et al. [
3]. The procedure was successful, comfortable, and safe in all patients. Patients reported low level of pain and good satisfaction with the procedure. …