Optimizing sedation in patients with acute brain injury.

Détails

Ressource 1Télécharger: BIB_BD9B4AF52719.P001.pdf (774.91 [Ko])
Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_BD9B4AF52719
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Institution
Titre
Optimizing sedation in patients with acute brain injury.
Périodique
Critical care (London, England)
Auteur(s)
Oddo M., Crippa I.A., Mehta S., Menon D., Payen J.F., Taccone F.S., Citerio G.
ISSN
1466-609X (Electronic)
ISSN-L
1364-8535
Statut éditorial
Publié
Date de publication
05/05/2016
Peer-reviewed
Oui
Volume
20
Numéro
1
Pages
128
Langue
anglais
Notes
Publication types: Journal Article ; Review
Publication Status: epublish
Résumé
Daily interruption of sedative therapy and limitation of deep sedation have been shown in several randomized trials to reduce the duration of mechanical ventilation and hospital length of stay, and to improve the outcome of critically ill patients. However, patients with severe acute brain injury (ABI; including subjects with coma after traumatic brain injury, ischaemic/haemorrhagic stroke, cardiac arrest, status epilepticus) were excluded from these studies. Therefore, whether the new paradigm of minimal sedation can be translated to the neuro-ICU (NICU) is unclear. In patients with ABI, sedation has 'general' indications (control of anxiety, pain, discomfort, agitation, facilitation of mechanical ventilation) and 'neuro-specific' indications (reduction of cerebral metabolic demand, improved brain tolerance to ischaemia). Sedation also is an essential therapeutic component of intracranial pressure therapy, targeted temperature management and seizure control. Given the lack of large trials which have evaluated clinically relevant endpoints, sedative selection depends on the effect of each agent on cerebral and systemic haemodynamics. Titration and withdrawal of sedation in the NICU setting has to be balanced between the risk that interrupting sedation might exacerbate brain injury (e.g. intracranial pressure elevation) and the potential benefits of enhanced neurological function and reduced complications. In this review, we provide a concise summary of cerebral physiologic effects of sedatives and analgesics, the advantages/disadvantages of each agent, the comparative effects of standard sedatives (propofol and midazolam) and the emerging role of alternative drugs (ketamine). We suggest a pragmatic approach for the use of sedation-analgesia in the NICU, focusing on some practical aspects, including optimal titration and management of sedation withdrawal according to ABI severity.

Mots-clé
Analgesia/adverse effects, Analgesia/methods, Brain Injuries/complications, Brain Injuries/drug therapy, Critical Care/methods, Critical Illness/nursing, Deep Sedation/adverse effects, Deep Sedation/methods, Deep Sedation/standards, Humans, Hypnotics and Sedatives/adverse effects, Hypnotics and Sedatives/pharmacology, Hypnotics and Sedatives/therapeutic use, Intensive Care Units, Ketamine/adverse effects, Ketamine/pharmacology, Ketamine/therapeutic use, Midazolam/adverse effects, Midazolam/pharmacology, Midazolam/therapeutic use, Propofol/adverse effects, Propofol/pharmacology, Propofol/therapeutic use, Respiration, Artificial/adverse effects, Respiration, Artificial/nursing
Pubmed
Open Access
Oui
Création de la notice
28/05/2016 9:02
Dernière modification de la notice
20/08/2019 15:31
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