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Analgesia and sedation in patients with ARDS
- Source :
- Intensive Care Medicine, Intensive Care Medicine, Springer Verlag, 2020, 46 (12), pp.2342-2356. ⟨10.1007/s00134-020-06307-9⟩, Intensive Care Medicine, 2020, 46 (12), pp.2342-2356. ⟨10.1007/s00134-020-06307-9⟩, Chanques, G, Constantin, J M, Devlin, J W, Ely, E W, Fraser, G L, Gélinas, C, Girard, T D, Guérin, C, Jabaudon, M, Jaber, S, Mehta, S, Langer, T, Murray, M J, Pandharipande, P, Patel, B, Payen, J F, Puntillo, K, Rochwerg, B, Shehabi, Y, Strøm, T, Olsen, H T & Kress, J P 2020, ' Analgesia and sedation in patients with ARDS ', Intensive Care Medicine, vol. 46, no. 12, pp. 2342–2356 . https://doi.org/10.1007/s00134-020-06307-9
- Publication Year :
- 2020
- Publisher :
- HAL CCSD, 2020.
-
Abstract
- Acute Respiratory Distress Syndrome (ARDS) is one of the most demanding conditions in an Intensive Care Unit (ICU). Management of analgesia and sedation in ARDS is particularly challenging. An expert panel was convened to produce a “state-of-the-art” article to support clinicians in the optimal management of analgesia/sedation in mechanically ventilated adults with ARDS, including those with COVID-19. Current ICU analgesia/sedation guidelines promote analgesia first and minimization of sedation, wakefulness, delirium prevention and early rehabilitation to facilitate ventilator and ICU liberation. However, these strategies cannot always be applied to patients with ARDS who sometimes require deep sedation and/or paralysis. Patients with severe ARDS may be under-represented in analgesia/sedation studies and currently recommended strategies may not be feasible. With lightened sedation, distress-related symptoms (e.g., pain and discomfort, anxiety, dyspnea) and patient-ventilator asynchrony should be systematically assessed and managed through interprofessional collaboration, prioritizing analgesia and anxiolysis. Adaptation of ventilator settings (e.g., use of a pressure-set mode, spontaneous breathing, sensitive inspiratory trigger) should be systematically considered before additional medications are administered. Managing the mechanical ventilator is of paramount importance to avoid the unnecessary use of deep sedation and/or paralysis. Therefore, applying an “ABCDEF-R” bundle (R = Respiratory-drive-control) may be beneficial in ARDS patients. Further studies are needed, especially regarding the use and long-term effects of fast-offset drugs (e.g., remifentanil, volatile anesthetics) and the electrophysiological assessment of analgesia/sedation (e.g., electroencephalogram devices, heart-rate variability, and video pupillometry). This review is particularly relevant during the COVID-19 pandemic given drug shortages and limited ICU-bed capacity.
- Subjects :
- medicine.medical_specialty
ARDS
Sedation
medicine.medical_treatment
Pain medicine
[SDV]Life Sciences [q-bio]
Remifentanil
Guidelines as Topic
Review
Critical Care and Intensive Care Medicine
law.invention
03 medical and health sciences
Mechanical ventilation
0302 clinical medicine
law
Anesthesiology
medicine
Humans
Hypnotics and Sedatives
Pain Management
Intensive care unit
MED/41 - ANESTESIOLOGIA
Intensive care medicine
ComputingMilieux_MISCELLANEOUS
Respiratory Distress Syndrome
Acute respiratory distress syndrome
business.industry
Rehabilitation
COVID-19
030208 emergency & critical care medicine
medicine.disease
3. Good health
[SDV] Life Sciences [q-bio]
030228 respiratory system
Delirium
Analgesia
medicine.symptom
business
medicine.drug
Subjects
Details
- Language :
- English
- ISSN :
- 03424642 and 14321238
- Database :
- OpenAIRE
- Journal :
- Intensive Care Medicine, Intensive Care Medicine, Springer Verlag, 2020, 46 (12), pp.2342-2356. ⟨10.1007/s00134-020-06307-9⟩, Intensive Care Medicine, 2020, 46 (12), pp.2342-2356. ⟨10.1007/s00134-020-06307-9⟩, Chanques, G, Constantin, J M, Devlin, J W, Ely, E W, Fraser, G L, Gélinas, C, Girard, T D, Guérin, C, Jabaudon, M, Jaber, S, Mehta, S, Langer, T, Murray, M J, Pandharipande, P, Patel, B, Payen, J F, Puntillo, K, Rochwerg, B, Shehabi, Y, Strøm, T, Olsen, H T & Kress, J P 2020, ' Analgesia and sedation in patients with ARDS ', Intensive Care Medicine, vol. 46, no. 12, pp. 2342–2356 . https://doi.org/10.1007/s00134-020-06307-9
- Accession number :
- edsair.doi.dedup.....74e28511c7fc742b48c71773eff804b8