Analgesia y sedación en los pacientes con ventilación mecánica. Una encuesta nacional de la práctica clínica
Analgesia and sedation of mechanically ventilated patients - a national survey of clinical practice.
Wøien H, Stubhaug A, Bjørk IT.
Rikshospitalet Medical Centre, Oslo University Hospital, Norway.hilde.woien@ous-hf.no
Acta Anaesthesiol Scand. 2012 Jan;56(1):23-9. doi: 10.1111/j.1399-6576.2011.02524.x. Epub 2011 Sep 26.
Abstract
BACKGROUND: The importance of balanced sedation and pain treatment in intensive care units (ICUs) is evident, but regimes and use of medication differ widely. Previous surveys have focused on the use of various medications and regimes. What has not been explored is the process by which nurses and physicians assess patients' needs and work together toward a defined level of sedation and pain for the ICU patient. The purpose of the study was to determine the use of protocols and medications for sedation and analgesia in Norwegian ICUs and the degree of cooperation between nurses and physicians in using them. METHODS: A national survey was conducted in autumn 2007, using postal self-administered questionnaires. RESULTS: Written pain treatment and sedation protocols were not routinely used in Norwegian ICUs; however, half of the departments titrated sedation according to a scoring system, most commonly the Motor Activity Assessment Score. The most commonly used sedatives were propofol and midazolam, while fentanyl and morphine were the most used analgesics. The majority of respondents were concerned about the side effects of sedation and analgesics, leading to circulatory instability and delayed awakening. Nurses and physicians agreed upon the main indications for sedation: patient tolerance for ventilation, tolerance for medical and nursing interventions, and patient symptoms. CONCLUSIONS: Potential factors which may improve sedation and pain management of mechanically ventilated patients in Norwegian ICUs are more systematic assessments of pain and sedation, and the use of written protocols. Strategies which reduce side effects should be addressed.
http://onlinelibrary.wiley.com/doi/10.1111/j.1399-6576.2011.02524.x/pdf
Sedación controlada por el paciente: un novedoso abordaje del manejo de los pacientes en ventilación mecánica
Patient-controlled sedation: a novel approach to sedation management for mechanically ventilated patients.
Chlan LL, Weinert CR, Skaar DJ, Tracy MF.
School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455, USA. chlan001@umn.edu
Chest. 2010 Nov;138(5):1045-53. Epub 2010 Mar 18.
Abstract
BACKGROUND: Patient self-administration of medications for analgesia and procedural sedation is common. However, it is not known whether mechanically ventilated ICU patients can self-administer their own sedation to manage symptoms. METHODS: This descriptive pilot study examined the safety, adequacy, and satisfaction of patient-controlled sedation (PCS) with a convenience sample of critically ill, mechanically ventilated patients (N = 17) in the ICUs at University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota. Dexmedetomidine was administered via a patient-demand infusion pump system for a maximum of 24 h. Pumps were programmed with basal infusion plus patient-triggered boluses; nurses adjusted the basal infusion based on a dosing algorithm. Data were collected on sedation adequacy, additional dosing of analgesics and sedatives, hemodynamic parameters, safety of PCS, patient satisfaction with PCS, and nurse satisfaction with PCS. RESULTS: Although a majority of the hemodynamic values were within the established safety parameters for the study, 25% of patients experienced mild adverse physiologic effects. Furthermore, despite patients' perception of sedation adequacy with PCS, 70% received supplemental opiates or benzodiazepine medications while participating in the study. Patients rated dexmedetomidine PCS favorably for self-management of anxiety, level of relaxation obtained, and comfort in self-administering sedation. Nurses also were generally satisfied with PCS as a method of sedation, dexmedetomidine as the sedative, and patient response to the sedation. CONCLUSIONS: PCS warrants further investigation as a means to promote comfort in mechanically ventilated critically ill patients
http://journal.publications.chestnet.org/data/Journals/CHEST/
20451/092615.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Analgesia and sedation of mechanically ventilated patients - a national survey of clinical practice.
Wøien H, Stubhaug A, Bjørk IT.
Rikshospitalet Medical Centre, Oslo University Hospital, Norway.hilde.woien@ous-hf.no
Acta Anaesthesiol Scand. 2012 Jan;56(1):23-9. doi: 10.1111/j.1399-6576.2011.02524.x. Epub 2011 Sep 26.
Abstract
BACKGROUND: The importance of balanced sedation and pain treatment in intensive care units (ICUs) is evident, but regimes and use of medication differ widely. Previous surveys have focused on the use of various medications and regimes. What has not been explored is the process by which nurses and physicians assess patients' needs and work together toward a defined level of sedation and pain for the ICU patient. The purpose of the study was to determine the use of protocols and medications for sedation and analgesia in Norwegian ICUs and the degree of cooperation between nurses and physicians in using them. METHODS: A national survey was conducted in autumn 2007, using postal self-administered questionnaires. RESULTS: Written pain treatment and sedation protocols were not routinely used in Norwegian ICUs; however, half of the departments titrated sedation according to a scoring system, most commonly the Motor Activity Assessment Score. The most commonly used sedatives were propofol and midazolam, while fentanyl and morphine were the most used analgesics. The majority of respondents were concerned about the side effects of sedation and analgesics, leading to circulatory instability and delayed awakening. Nurses and physicians agreed upon the main indications for sedation: patient tolerance for ventilation, tolerance for medical and nursing interventions, and patient symptoms. CONCLUSIONS: Potential factors which may improve sedation and pain management of mechanically ventilated patients in Norwegian ICUs are more systematic assessments of pain and sedation, and the use of written protocols. Strategies which reduce side effects should be addressed.
http://onlinelibrary.wiley.com/doi/10.1111/j.1399-6576.2011.02524.x/pdf
Sedación controlada por el paciente: un novedoso abordaje del manejo de los pacientes en ventilación mecánica
Patient-controlled sedation: a novel approach to sedation management for mechanically ventilated patients.
Chlan LL, Weinert CR, Skaar DJ, Tracy MF.
School of Nursing, University of Minnesota, 5-160 Weaver-Densford Hall, 308 Harvard St SE, Minneapolis, MN 55455, USA. chlan001@umn.edu
Chest. 2010 Nov;138(5):1045-53. Epub 2010 Mar 18.
Abstract
BACKGROUND: Patient self-administration of medications for analgesia and procedural sedation is common. However, it is not known whether mechanically ventilated ICU patients can self-administer their own sedation to manage symptoms. METHODS: This descriptive pilot study examined the safety, adequacy, and satisfaction of patient-controlled sedation (PCS) with a convenience sample of critically ill, mechanically ventilated patients (N = 17) in the ICUs at University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota. Dexmedetomidine was administered via a patient-demand infusion pump system for a maximum of 24 h. Pumps were programmed with basal infusion plus patient-triggered boluses; nurses adjusted the basal infusion based on a dosing algorithm. Data were collected on sedation adequacy, additional dosing of analgesics and sedatives, hemodynamic parameters, safety of PCS, patient satisfaction with PCS, and nurse satisfaction with PCS. RESULTS: Although a majority of the hemodynamic values were within the established safety parameters for the study, 25% of patients experienced mild adverse physiologic effects. Furthermore, despite patients' perception of sedation adequacy with PCS, 70% received supplemental opiates or benzodiazepine medications while participating in the study. Patients rated dexmedetomidine PCS favorably for self-management of anxiety, level of relaxation obtained, and comfort in self-administering sedation. Nurses also were generally satisfied with PCS as a method of sedation, dexmedetomidine as the sedative, and patient response to the sedation. CONCLUSIONS: PCS warrants further investigation as a means to promote comfort in mechanically ventilated critically ill patients
http://journal.publications.chestnet.org/data/Journals/CHEST/
20451/092615.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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