Allison Clemens
April
ababaabhay
achoi2392
adhoward1

Post-Intubation Sedation and Analgesia Rabbit Hole: Post-Intubation Sedation and Analgesia

Lesson 2 of 2

In Progress

← Previous

Rabbit Hole: Post-Intubation Sedation and Analgesia

Guidelines

Devlin JW. SCCM 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018 Sep;46(9):e825-e873. doi: 10.1097/CCM.0000000000003299. PMID: 30113379.

Primary Literature

Pharmacists & Sedation Time Based on Paralytics

Robey-Gavin E, Abubakar L. Impact of Clinical Pharmacists on Initiation of Postintubation Analgesia in the Emergency Department. J Emerg Med. 2016 Feb;50(2):308-14. doi: 10.1016/j.jemermed.2015.07.029. PMID: 26433427.

Amini A, Faucett EA, Watt JM, Amini R, Sakles JC, Rhee P, Erstad BL, Patanwala AE. Effect of a pharmacist on timing of postintubation sedative and analgesic use in trauma resuscitations. Am J Health Syst Pharm. 2013 Sep 1;70(17):1513-7. doi: 10.2146/ajhp120673. PMID: 23943183.

Johnson EG, Meier A, Shirakbari A, Weant K, Baker Justice S. Impact of Rocuronium and Succinylcholine on Sedation Initiation After Rapid Sequence Intubation. J Emerg Med. 2015 Jul;49(1):43-9. doi: 10.1016/j.jemermed.2014.12.028. Epub 2015 Mar 19. PMID: 25797938.

Maison O, Tardy C, Offrey JM, Boselli E, Piriou V, Parat S, Allaouchiche B. Compliance with sedation analgesia protocols: Do clinical pharmacists have an impact? J Clin Pharm Ther. 2020 Feb;45(1):59-64. doi: 10.1111/jcpt.13023. Epub 2019 Oct 29. PMID: 31660644.

Hahn L, Beall J, Turner RS, Woolley TW, Hahn M. Pharmacist-developed sedation protocol and impact on ventilator days. J Pharm Pract. 2013 Aug;26(4):406-8. doi: 10.1177/0897190012467209. Epub 2012 Dec 2. PMID: 23204145.

Forni A, Skehan N, Hartman CA, Yogaratnam D, Njoroge M, Schifferdecker C, Lilly CM. Evaluation of the impact of a tele-ICU pharmacist on the management of sedation in critically ill mechanically ventilated patients. Ann Pharmacother. 2010 Mar;44(3):432-8. doi: 10.1345/aph.1M576. Epub 2010 Feb 17. PMID: 20164471.

Marshall J, Finn CA, Theodore AC. Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay. Crit Care Med. 2008 Feb;36(2):427-33. doi: 10.1097/01.CCM.0000300275.63811.B3. PMID: 18091554.

Stollings JL, Foss JJ, Ely EW, Ambrose AM, Rice TW, Girard TD, Wheeler AP. Pharmacist leadership in ICU quality improvement: coordinating spontaneous awakening and breathing trials. Ann Pharmacother. 2015 Aug;49(8):883-91.

Korinek JD, Thomas RM, Goddard LA, St John AE, Sakles JC, Patanwala AE. Comparison of rocuronium and succinylcholine on postintubation sedative and analgesic dosing in the emergency department. Eur J Emerg Med. 2014 Jun;21(3):206-11. doi: 10.1097/MEJ.0b013e3283606b89. PMID: 23510899.

Watt JM, Amini A, Traylor BR, Amini R, Sakles JC, Patanwala AE. Effect of paralytic type on time to post-intubation sedative use in the emergency department. Emerg Med J. 2013 Nov;30(11):893-5. doi: 10.1136/emermed-2012-201812. Epub 2012 Nov 8. PMID: 23139098.

Kendrick DB, Monroe KW, Bernard DW, Tofil NM. Sedation after intubation using etomidate and a long-acting neuromuscular blocker. Pediatr Emerg Care. 2009 Jun;25(6):393-6. doi: 10.1097/PEC.0b013e3181a7923b. PMID: 19458564.

Pappal RD, Roberts BW, Mohr NM, Ablordeppey E, Wessman BT, Drewry AM, Winkler W, Yan Y, Kollef MH, Avidan MS, Fuller BM. The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021 May;77(5):532-544. doi: 10.1016/j.annemergmed.2020.10.012. Epub 2021 Jan 21. PMID: 33485698; PMCID: PMC8166299.

Chong ID, Sandefur BJ, Rimmelin DE, Arbelaez C, Brown CA 3rd, Walls RM, Pallin DJ. Long-acting neuromuscular paralysis without concurrent sedation in emergency care. Am J Emerg Med. 2014 May;32(5):452-6. doi: 10.1016/j.ajem.2014.01.002. Epub 2014 Jan 15. PMID: 24650718.

Benzodiazepines

Fraser GL, Devlin JW, Worby CP, Alhazzani W, Barr J, Dasta JF, Kress JP, Davidson JE, Spencer FA. Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill adults: a systematic review and meta-analysis of randomized trials. Crit Care Med. 2013 Sep;41(9 Suppl 1):S30-8. doi: 10.1097/CCM.0b013e3182a16898. PMID: 23989093.
Gulla KM, Sankar J, Jat KR, Kabra SK, Lodha R. Dexmedetomidine vs Midazolam for Sedation in Mechanically Ventilated Children: A Randomized Controlled Trial. Indian Pediatr. 2021 Feb 15;58(2):117-122. PMID: 33632940.
Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG; SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009 Feb 4;301(5):489-99. doi: 10.1001/jama.2009.56. Epub 2009 Feb 2. PMID: 19188334.

Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 2007;298:2644-53

Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 2012;307:1151-60.

Pandharipande P, Shintani A, Peterson J. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006 Jan;104(1):21-6.

Lonardo NW, Mone MC, Nirula R. Propofol is associated with favorable outcomes compared with benzodiazepines in ventilated intensive care unit patients. Am J Respir Crit Care Med. 2014 Jun 1;189(11):1383-94.

Dexmedetomidine

Shehabi Y, Howe BD, Bellomo R, Arabi YM, Bailey M, Bass FE, Bin Kadiman S, McArthur CJ, Murray L, Reade MC, Seppelt IM, Takala J, Wise MP, Webb SA; ANZICS Clinical Trials Group and the SPICE III Investigators. Early Sedation with Dexmedetomidine in Critically Ill Patients. N Engl J Med. 2019 Jun 27;380(26):2506-2517. doi: 10.1056/NEJMoa1904710. Epub 2019 May 19. PMID: 31112380.

Kawazoe Y, Miyamoto K, Morimoto T, Yamamoto T, Fuke A, Hashimoto A, Koami H, Beppu S, Katayama Y, Itoh M, Ohta Y, Yamamura H; Dexmedetomidine for Sepsis in Intensive Care Unit Randomized Evaluation (DESIRE) Trial Investigators. Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: A Randomized Clinical Trial. JAMA. 2017 Apr 4;317(13):1321-1328. doi: 10.1001/jama.2017.2088. PMID: 28322414; PMCID: PMC5469298.

Huang F, Wang J, Yang X, Xu H, Kong J, Liu S, Jin J. [Sedative effects of dexmedetomidine in post-operative elder patients on mechanical ventilation]. Zhonghua Yi Xue Za Zhi. 2014 Nov 11;94(41):3211-5. Chinese. PMID: 25604219.

Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, Bratty JR, Takala J; Dexmedetomidine for Long-Term Sedation Investigators. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012 Mar 21;307(11):1151-60. doi: 10.1001/jama.2012.304. PMID: 22436955.

Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG; SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009 Feb 4;301(5):489-99. doi: 10.1001/jama.2009.56. Epub 2009 Feb 2. PMID: 19188334.

Ruokonen E, Parviainen I, Jakob SM, et al. Dexmedetomidine versus propofol/ midazolam for long-term sedation during mechanical ventilation. Intensive Care Med 2009;35:282-90

Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 2007;298:2644-53

Dasta JF, Kane-Gill SL, Pencina M, Shehabi Y, Bokesch PM, Wisemandle W, Riker RR. A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit. Crit Care Med. 2010 Feb;38(2):497-503. doi: 10.1097/CCM.0b013e3181bc81c9. PMID: 19789442.

Huang Z, Chen YS, Yang ZL, Liu JY. Dexmedetomidine versus midazolam for the sedation of patients with non-invasive ventilation failure. Intern Med. 2012;51(17):2299-305.

Reade MC, O’Sullivan K, Bates S, . Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Crit Care. 2009;13(3):R75.

Shehabi Y, Grant P, Wolfenden H. Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study). Anesthesiology. 2009 Nov;111(5):1075-84.

Propofol

Kondili E, Alexopoulou C, Xirouchaki N, Georgopoulos D. Effects of propofol on sleep quality in mechanically ventilated critically ill patients: a physiological study. Intensive Care Med. 2012 Oct;38(10):1640-6. doi: 10.1007/s00134-012-2623-z. Epub 2012 Jul 3. PMID: 22752356.

Vaschetto R, Cammarota G, Colombo D, Longhini F, Grossi F, Giovanniello A, Della Corte F, Navalesi P. Effects of propofol on patient-ventilator synchrony and interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med. 2014 Jan;42(1):74-82. doi: 10.1097/CCM.0b013e31829e53dc. PMID: 23982026.

Liu L, Wu AP, Yang Y, Liu SQ, Huang YZ, Xie JF, Pan C, Yang CS, Qiu HB. Effects of Propofol on Respiratory Drive and Patient-ventilator Synchrony during Pressure Support Ventilation in Postoperative Patients: A Prospective Study. Chin Med J (Engl). 2017 May 20;130(10):1155-1160. doi: 10.4103/0366-6999.205864. PMID: 28485314; PMCID: PMC5443020.
Pereira JV, Sanjanwala RM, Mohammed MK, Le ML, Arora RC. Dexmedetomidine versus propofol sedation in reducing delirium among older adults in the ICU: A systematic review and meta-analysis. Eur J Anaesthesiol. 2020 Feb;37(2):121-131. doi: 10.1097/EJA.0000000000001131. PMID: 31860605.
Conti G, Ranieri VM, Costa R, Garratt C, Wighton A, Spinazzola G, Urbino R, Mascia L, Ferrone G, Pohjanjousi P, Ferreyra G, Antonelli M. Effects of dexmedetomidine and propofol on patient-ventilator interaction in difficult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study. Crit Care. 2016 Jul 2;20(1):206. doi: 10.1186/s13054-016-1386-2. PMID: 27368279; PMCID: PMC4930611.
Elgebaly AS, Sabry M. Sedation effects by dexmedetomidine versus propofol in decreasing duration of mechanical ventilation after open heart surgery. Ann Card Anaesth. 2018 Jul-Sep;21(3):235-242. doi: 10.4103/aca.ACA_168_17. PMID: 30052208; PMCID: PMC6078043.
Carson SS, Kress JP, Rodgers JE, Vinayak A, Campbell-Bright S, Levitt J, Bourdet S, Ivanova A, Henderson AG, Pohlman A, Chang L, Rich PB, Hall J. A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients. Crit Care Med. 2006 May;34(5):1326-32. doi: 10.1097/01.CCM.0000215513.63207.7F. PMID: 16540958.

Lonardo NW, Mone MC, Nirula R. Propofol is associated with favorable outcomes compared with benzodiazepines in ventilated intensive care unit patients. Am J Respir Crit Care Med. 2014 Jun 1;189(11):1383-94.

Ketamine

Perbet S, Verdonk F, Godet T, Jabaudon M, Chartier C, Cayot S, Guerin R, Morand D, Bazin JE, Futier E, Pereira B, Constantin JM. Low doses of ketamine reduce delirium but not opiate consumption in mechanically ventilated and sedated ICU patients: A randomised double-blind control trial. Anaesth Crit Care Pain Med. 2018 Dec;37(6):589-595. doi: 10.1016/j.accpm.2018.09.006. Epub 2018 Sep 27. PMID: 30268528.

Analgosedative adjuncT keTAmine Infusion iN Mechanically vENTilated ICU Patients (ATTAINMENT) – https://clinicaltrials.gov/ct2/show/NCT04075006?cond=propofol+for+mechanically+ventilated+patient&draw=2&rank=12

Manasco AT, Stephens RJ, Yaeger LH, Roberts BW, Fuller BM. Ketamine sedation in mechanically ventilated patients: A systematic review and meta-analysis. J Crit Care. 2020 Apr;56:80-88. doi: 10.1016/j.jcrc.2019.12.004. Epub 2019 Dec 9. PMID: 31865256.

Opioids

Liu KB, Wang DH, Ma Y, Xia R. [Remifentanil for analgesia and sedation in mechanically ventilated patients in intensive care unit]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013 Mar;25(3):167-70. Chinese. PMID: 23798067.

Rozendaal FW, Spronk PE, Snellen FF, Schoen A, van Zanten AR, Foudraine NA, Mulder PG, Bakker J; UltiSAFE investigators. Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: a centre randomised, cross-over, open-label study in the Netherlands. Intensive Care Med. 2009 Feb;35(2):291-8. doi: 10.1007/s00134-008-1328-9. Epub 2008 Oct 24. PMID: 18949456.

Robleda G, Roche-Campo F, Sendra MÀ, Navarro M, Castillo A, Rodríguez-Arias A, Juanes-Borrego E, Gich I, Urrutia G, Nicolás-Arfelis JM, Puntillo K, Mancebo J, Baños JE. Fentanyl as pre-emptive treatment of pain associated with turning mechanically ventilated patients: a randomized controlled feasibility study. Intensive Care Med. 2016 Feb;42(2):183-91. doi: 10.1007/s00134-015-4112-7. Epub 2015 Nov 10. PMID: 26556618.

Robleda G, Roche-Campo F, Urrútia G, Navarro M, Sendra MÀ, Castillo A, Rodríguez-Arias A, Juanes-Borrejo E, Gich I, Mancebo J, Baños JE. A randomized controlled trial of fentanyl in the pre-emptive treatment of pain associated with turning in patients under mechanical ventilation: research protocol. J Adv Nurs. 2015 Feb;71(2):441-50. doi: 10.1111/jan.12513. Epub 2014 Aug 28. PMID: 25168967.

Ancora G, Lago P, Garetti E, Pirelli A, Merazzi D, Pierantoni L, Ferrari F, Faldella G. Follow-up at the corrected age of 24 months of preterm newborns receiving continuous infusion of fentanyl for pain control during mechanical ventilation. Pain. 2017 May;158(5):840-845. doi: 10.1097/j.pain.0000000000000839. PMID: 28240994.

Wanzuita R, Poli-de-Figueiredo LF, Pfuetzenreiter F, et al. Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial. Crit Care 2012;16:R49.

Al-Qadheeb NS, Roberts RJ, Griffin R, Garpestad E, Ruthazer R, Devlin JW. Impact of enteral methadone on the ability to wean off continuously infused opioids in critically ill, mechanically ventilated adults: a case-control study. Ann Pharmacother. 2012 Sep;46(9):1160-6. doi: 10.1345/aph.1R132. Epub 2012 Aug 7. PMID: 22872749.

Robleda G, Roche-Campo F, Sendra MÀ. Fentanyl as pre-emptive treatment of pain associated with turning mechanically ventilated patients: a randomized controlled feasibility study. Intensive Care Med. 2016 Feb;42(2):183-91. doi: 10.1007/s00134-015-4112-7. Epub 2015 Nov 10. PMID: 26556618.

Richmond Agitation and Sedation Scale- Clinical Trial

TEAM Study Investigators, Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H, Denehy L, Harrold M, Higgins A, Presneill J, Saxena M, Skinner E, Young P, Webb S. Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care. 2015 Feb 26;19(1):81. doi: 10.1186/s13054-015-0765-4. PMID: 25715872; PMCID: PMC4342087.

Ramsay Sedation Scale – Clinical Trial

Hsu CW, Sun SF, Chu KA, Lee DL, Wong KF. Monitoring sedation for bronchoscopy in mechanically ventilated patients by using the Ramsay sedation scale versus auditory-evoked potentials. BMC Pulm Med. 2014 Feb 6;14:15. doi: 10.1186/1471-2466-14-15. PMID: 24499010; PMCID: PMC3917902.

Critical-Care Pain Observation Tool

Yuan SC, Cao WJ, Huang Y, Hua SY, Zhou YH, Cai R. [Effect of acupuncture on analgesia and sedation in elderly patients with severe pneumonia during invasive mechanical ventilation]. Zhongguo Zhen Jiu. 2021 Sep 12;41(9):971-8. Chinese. doi: 10.13703/j.0255-2930.20200903-k0004. PMID: 34491645.

Yaman Aktaş Y, Karabulut N. The effects of music therapy in endotracheal suctioning of mechanically ventilated patients. Nurs Crit Care. 2016 Jan;21(1):44-52. doi: 10.1111/nicc.12159. Epub 2015 Feb 26. PMID: 25721305.

Yaman Aktaş Y, Karabulut N. Relief of Procedural Pain in Critically Ill Patients by Music Therapy: A Randomized Controlled Trial. Complement Med Res. 2019;26(3):156-165. English. doi: 10.1159/000495301. Epub 2019 Mar 20. PMID: 30897585.

Others

Oyler DR, Parli SE, Bernard AC, et al. Nonopioid management of acute pain associated with trauma: focus on pharmacologic options. J Trauma Acute Care Surg 2015;79:475-83.

Aitken LM, Bucknall T, Kent B, et al. Protocol-directed sedation versus non-protocol-directed sedation to reduce duration of mechanical ventilation in mechanically ventilated intensive care patients.

Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010 Feb 6;375(9713):475-80. doi: 10.1016/S0140-6736(09)62072-9. Epub 2010 Jan 29. PMID: 20116842.

White KE, Szumita PM, Gilboy N, Keenan HA, Arbelaez C. Implementation of a guideline for the treatment of pain, sedation, agitation and neuromuscular blockade in the mechanically ventilated adult patient in the emergency department. Open Access Emerg Med. 2011 Apr 8;3:21-7. doi: 10.2147/OAEM.S17042. PMID: 27147848; PMCID: PMC4753963.

Treggiari MM, Romand JA, Yanez ND, Deem SA, Goldberg J, Hudson L, Heidegger CP, Weiss NS. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med. 2009 Sep;37(9):2527-34. doi: 10.1097/CCM.0b013e3181a5689f. PMID: 19602975.

Khan SH, Wang S, Harrawood A, Martinez S, Heiderscheit A, Chlan L, Perkins AJ, Tu W, Boustani M, Khan B. Decreasing Delirium through Music (DDM) in critically ill, mechanically ventilated patients in the intensive care unit: study protocol for a pilot randomized controlled trial. Trials. 2017 Nov 29;18(1):574. doi: 10.1186/s13063-017-2324-6. PMID: 29187230; PMCID: PMC5708104.

Mehta S, Burry L, Cook D, Fergusson D, Steinberg M, Granton J, Herridge M, Ferguson N, Devlin J, Tanios M, Dodek P, Fowler R, Burns K, Jacka M, Olafson K, Skrobik Y, Hébert P, Sabri E, Meade M; SLEAP Investigators; Canadian Critical Care Trials Group. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA. 2012 Nov 21;308(19):1985-92. doi: 10.1001/jama.2012.13872. Erratum in: JAMA. 2013 Jan 16;309(3):237. PMID: 23180503.

Devabhakthuni S, Kapoor K, Verceles AC, Netzer G, Ludmir J, Ramani G, Chaudhry A, Bolgiano M, Pollock JS, Mccurdy MT. Financial impact of an analgosedation protocol for mechanically ventilated patients in a cardiovascular intensive care unit. Am J Health Syst Pharm. 2020 Jan 1;77(1):14-21. doi: 10.1093/ajhp/zxz265. PMID: 31800956.

Sharma A, Singh PM, Trikha A, Rewari V, Chandralekha. Entropy correlates with Richmond Agitation Sedation Scale in mechanically ventilated critically ill patients. J Clin Monit Comput. 2014 Apr;28(2):193-201. doi: 10.1007/s10877-013-9517-7. PMID: 24122077.
Croce MA, Brasel KJ, Coimbra R, Adams CA Jr, Miller PR, Pasquale MD, McDonald CS, Vuthipadadon S, Fabian TC, Tolley EA. National Trauma Institute prospective evaluation of the ventilator bundle in trauma patients: does it really work? J Trauma Acute Care Surg. 2013 Feb;74(2):354-60; discussion 360-2. doi: 10.1097/TA.0b013e31827a0c65. PMID: 23354225.
Khan BA, Fadel WF, Tricker JL, Carlos WG, Farber MO, Hui SL, Campbell NL, Ely EW, Boustani MA. Effectiveness of implementing a wake up and breathe program on sedation and delirium in the ICU. Crit Care Med. 2014 Dec;42(12):e791-5. doi: 10.1097/CCM.0000000000000660. PMID: 25402299; PMCID: PMC4311879.

Mistraletti G, Umbrello M, Salini S, Cadringher P, Formenti P, Chiumello D, Villa C, Russo R, Francesconi S, Valdambrini F, Bellani G, Palo A, Riccardi F, Ferretti E, Festa M, Gado AM, Taverna M, Pinna C, Barbiero A, Ferrari PA, Iapichino G; SedaEN investigators. Enteral versus intravenous approach for the sedation of critically ill patients: a randomized and controlled trial. Crit Care. 2019 Jan 7;23(1):3. doi: 10.1186/s13054-018-2280-x. PMID: 30616675; PMCID: PMC6323792.

Olsen HT, Nedergaard HK, Strøm T, Oxlund J, Wian KA, Ytrebø LM, Kroken BA, Chew M, Korkmaz S, Lauridsen JT, Toft P. Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients. N Engl J Med. 2020 Mar 19;382(12):1103-1111. doi: 10.1056/NEJMoa1906759. Epub 2020 Feb 16. PMID: 32068366.

Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, McArthur C, Murray L, Seppelt IM, Webb S, Weisbrodt L; Sedation Practice in Intensive Care Evaluation Study Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group. Early goal-directed sedation versus standard sedation in mechanically ventilated critically ill patients: a pilot s. Crit Care Med. 2013 Aug;41(8):1983-91. doi: 10.1097/CCM.0b013e31828a437d. PMID: 23863230.

Mehta S, Meade M, Burry L, Mallick R, Katsios C, Fergusson D, Dodek P, Burns K, Herridge M, Devlin JW, Tanios M, Fowler R, Jacka M, Skrobik Y, Olafson K, Cook D; SLEAP Investigators and the Canadian Critical Care Trials Group. Variation in diurnal sedation in mechanically ventilated patients who are managed with a sedation protocol alone or a sedation protocol and daily interruption. Crit Care. 2016 Aug 1;20(1):233. doi: 10.1186/s13054-016-1405-3. PMID: 27480314; PMCID: PMC4968433.

Bugedo G, Tobar E, Aguirre M, Gonzalez H, Godoy J, Lira MT, Lora P, Encalada E, Hernandez A, Tomicic V, Castro J, Jara J, Andresen M, Ugarte H. The implementation of an analgesia-based sedation protocol reduced deep sedation and proved to be safe and feasible in patients on mechanical ventilation. Rev Bras Ter Intensiva. 2013 Jul-Sep;25(3):188-96. doi: 10.5935/0103-507X.20130034. PMID: 24213081; PMCID: PMC4031854.

Kaila M, Everingham K, Lapinlampi P, Peltola P, Särkelä MO, Uutela K, Walsh TS. A randomized controlled proof-of-concept trial of early sedation management using Responsiveness Index monitoring in mechanically ventilated critically ill patients. Crit Care. 2015 Sep 11;19(1):333. doi: 10.1186/s13054-015-1043-1. PMID: 26370687; PMCID: PMC4570737.

Guo K, Zhang H, Peng S. [Comparison of two schemes of daily arousal and comfort analgesia and sedation in patients on mechanical ventilation in intensive care unit]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Oct;30(10):950-952. Chinese. doi: 10.3760/cma.j.issn.2095-4352.2018.010.009. PMID: 30439315.
Vasilevskis EE, Pandharipande PP, Girard TD, Ely EW. A screening, prevention, and restoration model for saving the injured brain in intensive care unit survivors. Crit Care Med. 2010 Oct;38(10 Suppl):S683-91. doi: 10.1097/CCM.0b013e3181f245d3. PMID: 21164415; PMCID: PMC3679543.

Review articles

Noel C, Mallemat H. Sedation and Analgesia for Mechanically Ventilated Patients in the Emergency Department. Emerg Med Clin North Am. 2019 Aug;37(3):545-556. doi: 10.1016/j.emc.2019.04.004. Epub 2019 May 16. PMID: 31262420.

Garrett KM. Best Practices for Managing Pain, Sedation, and Delirium in the Mechanically Ventilated Patient. Crit Care Nurs Clin North Am. 2016 Dec;28(4):437-450. doi: 10.1016/j.cnc.2016.07.004. Epub 2016 Oct 27. PMID: 28236391.

Erstad BL, Barletta JF. Drug dosing in the critically ill obese patient-a focus on sedation, analgesia, and delirium. Crit Care. 2020 Jun 8;24(1):315. doi: 10.1186/s13054-020-03040-z. PMID: 32513237; PMCID: PMC7282067.

Chanques G, Constantin JM, Devlin JW, Ely EW, Fraser GL, Gélinas C, Girard TD, Guérin C, Jabaudon M, Jaber S, Mehta S, Langer T, Murray MJ, Pandharipande P, Patel B, Payen JF, Puntillo K, Rochwerg B, Shehabi Y, Strøm T, Olsen HT, Kress JP. Analgesia and sedation in patients with ARDS. Intensive Care Med. 2020 Dec;46(12):2342-2356. doi: 10.1007/s00134-020-06307-9. Epub 2020 Nov 10. PMID: 33170331; PMCID: PMC7653978.

Kotfis K, Marra A, Ely EW. ICU delirium – a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther. 2018;50(2):160-167. doi: 10.5603/AIT.a2018.0011. Epub 2018 Jun 8. PMID: 29882581.

Wang H, Wang C, Wang Y, Tong H, Feng Y, Li M, Jia L, Yu K. Sedative drugs used for mechanically ventilated patients in intensive care units: a systematic review and network meta-analysis. Curr Med Res Opin. 2019 Mar;35(3):435-446. doi: 10.1080/03007995.2018.1509573. Epub 2018 Sep 25. PMID: 30086671.

Devabhakthuni S, Armahizer MJ, Dasta JF, Kane-Gill SL. Analgosedation: a paradigm shift in intensive care unit sedation practice. Ann Pharmacother. 2012 Apr;46(4):530-40. doi: 10.1345/aph.1Q525. Epub 2012 Apr 10. PMID: 22496477.

Zhang Z, Chen K, Ni H, Zhang X, Fan H. Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis. Sci Rep. 2017 Mar 21;7:44979. doi: 10.1038/srep44979. PMID: 28322337; PMCID: PMC5359583.

Freeman CL, Evans CS, Barrett TW. Managing sedation in the mechanically ventilated emergency department patient: a clinical review. J Am Coll Emerg Physicians Open. 2020 Apr 10;1(3):263-269. doi: 10.1002/emp2.12045. PMID: 33000041; PMCID: PMC7493591.

Patel SB, Kress JP. Sedation and analgesia in the mechanically ventilated patient. Am J Respir Crit Care Med. 2012 Mar 1;185(5):486-97. doi: 10.1164/rccm.201102-0273CI. Epub 2011 Oct 20. PMID: 22016443.

Vagionas D, Vasileiadis I, Rovina N, Alevrakis E, Koutsoukou A, Koulouris N. Daily sedation interruption and mechanical ventilation weaning: a literature review. Anaesthesiol Intensive Ther. 2019;51(5):380-389. doi: 10.5114/ait.2019.90921. PMID: 31893604.

Porhomayon J, El-Solh AA, Adlparvar G, Jaoude P, Nader ND. Impact of Sedation on Cognitive Function in Mechanically Ventilated Patients. Lung. 2016 Feb;194(1):43-52. doi: 10.1007/s00408-015-9820-9. Epub 2015 Nov 11. PMID: 26559680.
Keating GM. Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting. Drugs. 2015 Jul;75(10):1119-30. doi: 10.1007/s40265-015-0419-5. PMID: 26063213.

Garrett KM. Best Practices for Managing Pain, Sedation, and Delirium in the Mechanically Ventilated Patient. Crit Care Nurs Clin North Am. 2016 Dec;28(4):437-450. doi: 10.1016/j.cnc.2016.07.004. Epub 2016 Oct 27. PMID: 28236391.

Chanques G, Constantin JM, Devlin JW, Ely EW, Fraser GL, Gélinas C, Girard TD, Guérin C, Jabaudon M, Jaber S, Mehta S, Langer T, Murray MJ, Pandharipande P, Patel B, Payen JF, Puntillo K, Rochwerg B, Shehabi Y, Strøm T, Olsen HT, Kress JP. Analgesia and sedation in patients with ARDS. Intensive Care Med. 2020 Dec;46(12):2342-2356. doi: 10.1007/s00134-020-06307-9. Epub 2020 Nov 10. PMID: 33170331; PMCID: PMC7653978.

Kotfis K, Marra A, Ely EW. ICU delirium – a diagnostic and therapeutic challenge in the intensive care unit. Anaesthesiol Intensive Ther. 2018;50(2):160-167. doi: 10.5603/AIT.a2018.0011. Epub 2018 Jun 8. PMID: 29882581.

Wang H, Wang C, Wang Y, Tong H, Feng Y, Li M, Jia L, Yu K. Sedative drugs used for mechanically ventilated patients in intensive care units: a systematic review and network meta-analysis. Curr Med Res Opin. 2019 Mar;35(3):435-446. doi: 10.1080/03007995.2018.1509573. Epub 2018 Sep 25. PMID: 30086671.

Devabhakthuni S, Armahizer MJ, Dasta JF, Kane-Gill SL. Analgosedation: a paradigm shift in intensive care unit sedation practice. Ann Pharmacother. 2012 Apr;46(4):530-40. doi: 10.1345/aph.1Q525. Epub 2012 Apr 10. PMID: 22496477.

Post-Intubation Sedation and Analgesia

Participants 396

Rabbit Hole: Post-Intubation Sedation and Analgesia

Guidelines

Primary Literature

Pharmacists & Sedation Time Based on Paralytics

Review articles

Podcasts

Blogs