sedation - Sedation in the ICU-drugs, regimens of...

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Unformatted text preview: Sedation in the ICU-drugs, regimens of administration and monitoring R. Srinivas Senior Resident, Dept. of Pulmonary medicine PGIMER 22 September 2006. Sedation in the ICU-why bother? 1.To relieve Dyspnea and intractable coughing 2.For amnesia during critical illness. 3.To manage agitated (delirious) patient from harming self and care- providers 4.To facilitate invasive management like ventilation and improve synchrony 5.To decrease VO2 and VCO2 (especially with cardiopulmonary compromise) 6. Unpleasant memories & ?PTSS The yin of sedation. Sedatives are commonly over-used. Substituted as pharmacological restraints. In a survey, <5% were agitated when assessed objectively. Likely to represent over-sedation. Associated with prolonged ventilation duration long ICU stays cognitive impairment complications of critical care critical care neuropathy critical care myopathy (NM agents with steroids) increased cost of care complications may be missed ? Pain induced immuno-suppression Ely et al. JAMA 2003; 289(22):2983-91 The yang of sedation. Agitation is common in the ICU. Pharmacological & physical measures commonly needed. Agitation is associated with Serious self harm Injury to health care providers Asynchrony during ventilation Barotrauma Increased WOB Hypoxia and decompensation AGITATION: Agitation is characterized by extreme arousal, irritability, excess motor activity driven by internal sense of discomfort such as disease, pain, anxiety and delirium. Anxiety: A sustained state of apprehension with accompanying autonomic arousal in response to a real or perceived threat. DELIRIUM: An acute, potentially reversible impairment of consciousness and cognitive function that fluctuates in severity. PAIN: is an unpleasant sensory & emotional experience associated with actual or potential tissue damage Som e d efinitions Delirium in the ICU. Feature 1: acute onset of mental status changes or a fluctuating course. Feature 2: inattention Feature 3: disorganized thinking Feature 4: altered level of consciousness and and or = Delirium AGITATION in the ICU PAIN DELIRIUM ILLNESS ANXIETY Physical problems Drugs/ Withdrawal Electrolyte abn infection CNS/ CVS dis Why agitation occurs in the ICU? Illness Environment/ iatrogenic Patient Illness Environment/ iatrogenic Patient 0 1 2 3 4 5 6 7 8 9 10 No pain some pain worst ever pain 1.Unidimensional pain rating scales Visual analog scale (for Pain) Other methods of quantification: 1.Verbal rating scale (VRS) 2.Numeric rating scale (NRS) 3.FACES scale (non verbal, non-oriented) Multidimensional pain rating scales Mc Gill pain questionnaire Wisconsin brief pain questionnaire Less useful in the ICU Behavioral pain rating scales Pain-related behaviors (movement, facial expression, and posturing) and physiological indicators (heart rate, blood pressure, and respiratory rate) and the change in these parameters following analgesic therapy can be used.(Grade of recommendation B) SCCM, ACCM. Crit Care Med 2002;30:123 Delirium in the ICU.Delirium in the ICU....
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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sedation - Sedation in the ICU-drugs, regimens of...

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