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Sedation in icu
This document discusses sedation in the intensive care unit (ICU). It outlines the aims of sedation as keeping patients comfortable and pain free while minimizing anxiety and allowing cooperation with care. It discusses subjective and objective assessment of sedation and outlines therapies for analgesia and sedation including non-pharmacological and pharmacological options. Benefits and risks of over and under sedation are presented. Different sedative agents are compared and factors in selecting an agent are outlined.
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Sedation in icu
- 1. Sedation in ICUSedationin ICU T Mphanza FRCA, FFICM
- 2. The correct managementof sedation is one of the most important aspects of Intensive Care management
- 4. AimsAims Comfortable and painfree Minimise anxiety Calm and co-operative Ability to tolerate appropriate organ system support Patients MUST NOT be paralysed and awake
- 5. Subjective ImpressionsSubjective Impressions BionJF. Sedation and analgesia in the intensive care unit. Hospital Update. 1988; 14:1271-1286.
- 6. Experience Recall of Experience (%) Reportedas Unpleasant (%) Anxiety 55 78 Pain 40 67 Thirst 67 60 ETT (N=50) 38 57 Face Mask 67 52 Physiotherapy 75 33 Urinary Catheter 75 17 Nausea 13 12 Paralysis 13 100
- 7. Critical Care 2007,11:R124 doi:10.1186/cc6189 Changes in sedation management in German intensive care units between 2002 and 2006: a national follow up surveyJoerg Martin (Joerg.Martin@email.de) Martin Franck (mfranck@pipeline.com) Stefan Sigel (Stefan.Sigel@kae.de) Manfred Weiss (manfred.weiss.ulm@onlin e.de) Claudia D Spies (claudia.spies@charite.de)
- 8. 82% response rate 67%changes in sedation managent Critical Care 2007, 11:R124 doi:10.1186/cc6189
- 9. Critical Care 2007,11:R124 doi:10.1186/cc6189
- 10. How often dowe get it right?How often do we get it right? Kaplan et al., Critical Care 2000; 4(1):s110 Olson D et al., NTI Proceedings 2003;CS 82:196
- 12. Does it matter?Doesit matter? Over - sedated Increased drug costs Delayed weaning Increased ICU LOS Increased testing
- 13. Does it matter?Doesit matter? Under-sedated Anxiety and agitation Awareness and recall PTSD Increased adverse events Increased use of NMR
- 14. AnalgesiaAnalgesia Why in pain: Pre-existingconditions Invasive procedures Therapeutic devices Catheters Drains NIV ETT
- 15. AnalgesiaAnalgesia Unrelieved pain Stress response: Tachycardia IncreasedO2 consumption Hypercoaguability Immunosuppression Persistent catabolism
- 16. AnalgesiaAnalgesia Pain assessment Unidimensional VAS VRS Multidimensional McGill PainQuestionnaire Wisconsin Brief Pain Questionnaire
- 17. AnalgesiaAnalgesia Pain Assessment Behavioural-physiological scales Behavioural Facialexpression Posture Movement Physiological RR HR BP
- 18. Analgesia TherapyAnalgesia Therapy Non-pharmacologic Properpositioning Stabilisation of fractures Pharmacologic Opioids NSAIDs Paracetamol
- 19. Analgesia TherapyAnalgesia Therapy Desirableattributes of opioids Rapid onset Ease of titration Lack of accumulation Low cost Lack of adverse effects
- 20. Analgesia TherapyAnalgesia Therapy OpioidAdministration Techniques Route IV Intermittent PCA Infusion Strategy Daily awakening
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- 22. SedationSedation Deleterious effects ofanxiety Ventilator dysynchrony Increased oxygen consumption Inadvertent removal of devices
- 23. SedationSedation Before sedation ensure: Correctphysiological anomalies Hypoxemia Hypoglycaemia Hypotension Pain Withdrawal from drugs
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- 29. Sedation AssessmentSedation Assessment Objective Vitalsigns Heart rate variability Lower-oesophageal contractility EEG BIS
- 30. Sedation TherapySedation Therapy Benzodiazepines Anterogradeamnesia No analgesic property Opioid-sparing
- 31. Sedation TherapySedation Therapy Propofol Centralalpha agonists Clonidine Dexmedetomidine
- 32. Sedative SelectionSedative Selection Outcomemeasures Speed of onset Ability to maintain target level of sedation Adverse effects Time to awakening Ability to wean from ventilation
- 33. Sedative SelectionSedative Selection Durationof Therapy Short-term Propofol V Midazolam Intermediate Propofol V Midazolam Propofol V Midazolam V Lorazepam Long-term Propofol V Midazolam
- 34. Sedative and AnalgesicSedativeand Analgesic WithdrawalWithdrawal Beware of withdrawal symptoms after more than one week of medication. Doses should be tapered systematically.
- 35. Sedation in ICUSedationin ICU An important component Most common therapy $ 1.2 billion per year Treatment should have specific and individualised goals