Добавил:
Upload Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз: Предмет: Файл:
Rajesh_Chawla_-_ICU_Protocols_A_stepwise_approa[1].pdf
Скачиваний:
259
Добавлен:
13.03.2016
Размер:
9.49 Mб
Скачать

33 Sedation and Analgesia

273

 

 

Step 7: Weaning from sedation and analgesia

Once the patient passes the SBT successfully, then converting the continuous infusion of the sedatives and analgesics into intermittent boluses is an effective option for early weaning.

Step 8: Reversal of oversedation

Excessive sedation involving benzodiazepines

Flumazenil

DoseÑ0.2 mg (2 mL) IV over 30 s. Wait 30 s and reassess. You may give additional 0.3 mg over 30 s, if needed, and reassess. Additional doses of 0.5 mg can be administered over 30 s at 1-min intervals as needed. Maximum cumulative dose is 3 mg.

Opioid reversal

Naloxone

DoseÑ0.1Ð2 mg IM/IV/SC. Titrate to patientsÕ response. It may be repeated at the interval of 2Ð3 min. Maximum dose is 10 mg.

Suggested Reading

1.Martin J, Heymann A, BŠsell K, Baron R, Biniek R, BŸrkle H, Dall P, Dictus C, Eggers V, et al. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care. Ger Med Sci. 2010;8:Doc02.

A recent exhaustive guideline from Germany based on Oxford grading scale.

2.Brush DR, Kress JP. Sedation and analgesia for the mechanically ventilated patient. Clin Chest Med. 2009;30(1):131Ð41, ix.

A comprehensive review article.

3.Sessler CN, Pedram S. Protocolized and target-based sedation and analgesia in the ICU. Crit Care Clin. 2009;25(3):489Ð513.

The article is devoted entirely to the subject of analgesia and sedation.

4.Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874Ð82.

5.Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, et al. Dexmedetomidine versus midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301(5):489Ð99.

At comparable sedation levels, dexmedetomidine-treated patients spent less time on the ventilator, experienced less delirium, and developed less tachycardia and hypertension. The most notable adverse effect of dexmedetomidine was bradycardia.

6.Sessler CN, Varney K. Patient-focused sedation and analgesia in the ICU. Chest. 2008;133:552Ð65.

7.Sessler CN. Sedation scales in the ICU. Chest. 2004;126:1727Ð30.

A comprehensively referenced article.

8.Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, ChalÞn DB, Masica MF. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30(1):119Ð41.

9.Hall RI, Sandham D, Cardinal P, Tweeddale M, Moher D, Wang X, Anis AH; Study Investigators. Propofol vs midazolam for ICU sedation: a Canadian multicenter randomized trial. Chest. 2001;119(4):1151Ð9.

274

A.K. Mani et al.

 

 

The use of propofol sedation allowed more rapid tracheal extubation than when midazolam sedation was employed. This did not result in earlier ICU discharge.

Websites

1.http://www.egms.de/static/en/journals/gms German guidelines on analgesia and sedation

2.http://chestjournal.chestpubs.org/content Sedation scales

3.www.consensus-conference.org/data/Upload/Consensus/1/pdf/1641.pdf

A full text article on analgesia and sedation in mechanically ventilated patients

4.www.icudelirium.org

A website of Vanderbilt University for update and practice parameters on ICU sedation

Соседние файлы в предмете [НЕСОРТИРОВАННОЕ]