Document Detail

Daily sedative interruption in mechanically ventilated patients at risk for coronary artery disease.
MedLine Citation:
PMID:  17205005     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: To determine the prevalence of myocardial ischemia in mechanically ventilated patients with coronary risk factors and compare periods of sedative interruption vs. sedative infusion. DESIGN: Prospective, blinded observational study. SETTING: Medical intensive care unit of tertiary care medical center. PATIENTS: Intubated, mechanically ventilated patients with established coronary artery disease risk factors. INTERVENTIONS: Continuous three-lead Holter monitors with ST-segment analysis by a blinded cardiologist were used to detect myocardial ischemia. Ischemia was defined as ST-segment elevation or depression of >0.1 mV from baseline. MEASUREMENTS AND MAIN RESULTS: Comparisons between periods of awakening from sedation vs. sedative infusion were made. Vital signs, catecholamine levels, and time with ischemia detected by Holter monitor during the two periods were compared. Heart rate, mean arterial pressure, rate-pressure product, respiratory rate, and catecholamine levels were all significantly higher during sedative interruption. Eighteen of 74 patients (24%) demonstrated ischemic changes. Patients with myocardial ischemia had a longer intensive care unit length of stay (17.4+/-17.5 vs. 9.6+/-6.7 days, p=.04). Despite changes in vital signs and catecholamine levels during sedative interruption, fraction of ischemic time did not differ between the time awake vs. time sedated [median [interquartile range] of 0% [0, 0] compared with 0% [0, 0] while they were sedated [p=.17]). The finding of similar fractions of ischemic time between awake and sedated states persisted with analysis of the subgroup of 18 patients with ischemia. CONCLUSIONS: Myocardial ischemia is common in critically ill mechanically ventilated patients with coronary artery disease risk factors. Daily sedative interruption is not associated with an increased occurrence of myocardial ischemia in these patients.
John P Kress; Ajeet G Vinayak; Joseph Levitt; William D Schweickert; Brian K Gehlbach; Frank Zimmerman; Anne S Pohlman; Jesse B Hall
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Critical care medicine     Volume:  35     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-01-25     Completed Date:  2007-03-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  365-71     Citation Subset:  AIM; IM    
Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
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MeSH Terms
Conscious Sedation / adverse effects*,  methods*
Coronary Artery Disease / complications*
Middle Aged
Myocardial Ischemia / epidemiology*,  etiology*
Respiration, Artificial / adverse effects*
Risk Factors
Grant Support
Comment In:
Crit Care Med. 2007 Feb;35(2):629-30   [PMID:  17251703 ]

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