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CURRENT ISSUEMINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036

Frequency: Monthly

ISSN 0375-9393

Online ISSN 1827-1596

 

Minerva Anestesiologica 2009 June;75(6):385-91

    EXPERT OPINIONS

Advances in sedation for critically ill patients

Morandi A. 1,2,3, Watson P. L. 1,4, Trabucchi M. 3,5, Wesley Ely E. 1,4,6

1 Center for Health Services Research, Vanderbilt Medical Center, Nashville, TN, USA;
2 Department of Internal Medicine and Geriatrics, Poliambulanza Hospital, Brescia, Italy;
3 Geriatric Research Group, Brescia, Italy;
4 Division of Allergy/Pulmonary/Critical Care Medicine, Vanderbilt Medical Center, Nashville, TN, USA;
5 University of Tor Vergata, Rome, Italy; 6VA Tennessee Valley Geriatric Research, Education and Clinical Center (GRECC), USA

The use of sedation is required for the majority of mechanically ventilated patients in order to ensure comfort. For many years, deep sedation was the standard of care to avoid unpleasant memories and anxiety and provide comfort. Research over the past decade has shown the importance of using different tools to assess the level of sedation in order to guide appropriate dosing of sedatives and to measure the clinical response to sedation. Given the progress in recent trials in this area, the management of sedation in the Intensive Care Unit (ICU) can be improved using various approaches that have shown improved outcomes in the ICU. The most prominent of these interventions involves linking daily interruptions in sedation (i.e. spontaneous awakening trials, SATs) with ventilator weaning protocols that incorporate spontaneous breathing trials (SBTs). Intensivists should combine the goals of ensuring patient comfort and avoiding unpleasant memories with other important goals that can be achieved with these new strategies (i.e. SATs plus SBTs or the so-called “wake up and breathe approach”), such as a three day reduction in time spent on the ventilator, a four day reduction in ICU and hospital stays and a 14% absolute reduction in death at one year. New choices for sedation, such as a-2 agonists and ultra short narcotics, are also being actively investigated, which may lead to complementary improvements in the future management of these critically ill, vulnerable patients.

language: English


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