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Sedation in The ICU PulmCrit
Sedation in The ICU PulmCrit
Sedation in The ICU PulmCrit
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Case
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PE
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Goals of Sedation
Control of pain
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Case contd
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Methods for assessing pain
Two of the most popular methods with well established validity and reliability
are the BPS and CPOT
The Behavior Pain Scale (BPS) is a scale based on a sum score of three items:
facial expression
Each pain indicator is scored from 1 (no response) to 4 (full response), with a
maximum score of 12.
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CPOT
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Opiates
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Opiates contd
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Opiates contd
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Analgesics to avoid in the ICU
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Case contd
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Assessing agitation
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Ramsay Sedation Scale
Response
Responding to commands
No response to stimulus
-2 Light sedation Briefly awakens with eye contact to voice (<10 seconds)
to physical stimulation
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Sedatives
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Benzos
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Benzos
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NMBA
Status epilepticus
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Non-depolarizing NMBA
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Rapid sequence intubation
agents
rapid onset of action which makes it useful for patients in whom RSI
is needed but in whom succinylcholine is contraindicated
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NMBA adverse effects
acute paresis
More NMBA pts received etomidate (83% vs. 35%) and more
non-NMBA patients received ketamine (39% vs. 9%) (p<0.001).
First attempt success for NMBA group was 80.9% vs. 69.6% for
non-NMBA p=0.003.
Neuromuscular Blockade Improves First Attempt Success for Intubation in the Intensive Care Unit: A
Propensity Matched Analysis Dr. Jarrod M Mosier, Annals of the American Thoracic Society
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NMBAs in ARDS
Mortality at 28 days was 23.7% (95% CI, 18.1 to 30.5) with cisatracurium and
33.3% (95% CI, 26.5 to 40.9) with placebo (P = 0.05).
Rate of ICU-acquired paresis did not differ significantly between the two
groups.
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What about sedation
vacation?
A randomized control trial of 128 patients by Kress et al:
TAKE AWAYS
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Critical
Opiates
the ICU
If
NMBA
Use
Sedation
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Any Questions?