On the issue of sedation of critically ill patients, in recent years is taking place internationally significant cultural revolution.
The use of sedative drugs, or a sedative analgesic drugs, lead to safe benefits for patients admitted to intensive care (comfort, decrease anxiety and agitation, ability to perform life-saving therapies), but show non-negligible side effects: cardio-respiratory depression, delayed weaning from mechanical ventilation, delirium, increased sepsis, worsening of neurological outcome after intensive care, increased mortality. For these reasons, the most important publications of recent years have stressed the importance of reducing the amount of sedatives used, offering a variety of hypotheses:
- Use of guide-lines aimed to reducing drug use;
- Sedation based on analgesia, with substantial reduction in the use of sedatives;
- Continuous monitoring of chance to wake-up patients and make them breathe spontaneously;
- Start early physical rehabilitation, to avoid the weakness induced immobility
All these strategies are aimed essentially to accept that patients hospitalized in intensive care unit are more 'awake than was necessary in the past. In particular, with the exception of the first 24 / 48 hours of admission, which may be necessary to maintain deep sedation to perform invasive procedures and for clinical stabilization, the aim to be pursued even in critically ill patients at high risk, which show prolonged critical conditions, it’s RASS = -1 / 0.
The maintenance of critically ill patients in a "quiet and awake" state, well adapted to the environment of the ICU and to the necessary invasive-care does not mean that you must stop the use of sedatives! The critically ill patients comfort is an essential goal that still has to be pursued, but that has proved compatible with the "conscious sedation".
The use of enteral sedation is an effective strategy to maintain an adequate sedation at least as intravenous sedation. However It has fewer cardio-respiratory side effects, presenting a slower pharmacokinetics to discontinuation of therapy may lead to a reduction of delirium induced by drugs. Finally it determines a marked reduction about hospital spending, for sedative drugs.
A new frontier in critical care: saving the injuried brain.
Gestire il doloreFlowchart dolore
Gestire la sedazioneFlowchart sedaz/agitaz
Gestire il deliriumFlowchart Delirium
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Finanziamento per la Ricerca Indipendente
(Decreto DGS 13456 del 22 dicembre 2010)