Document Detail

Use of sedation and neuromuscular blockers in critically ill adults receiving high-frequency oscillatory ventilation.
MedLine Citation:
PMID:  24259726     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Nearly all patients receive sedation and neuromuscular blockers (NMBs) during high-frequency oscillatory ventilation (HFOV).
OBJECTIVE: To describe analgo-sedation and NMB use prior to and during HFOV in adults with acute respiratory distress syndrome.
METHODS: Retrospective single-center study of 131 consecutive adults whose care was managed with HFOV from 2002 to 2011.
RESULTS: During the first 4 days of HFOV, 89% and 95% of patients received sedation and opioids, respectively. Upon HFOV initiation, 119 (90.8%) patients received fentanyl doses higher than 200 µg/h; of these, 48 also received more than 20 mg/h of midazolam. Analgo-sedation doses increased significantly over time such that doses were double by day 3. Factors independently associated with fentanyl doses higher than 200 µg/h were NMB ever used (OR 4.43; 95% CI 1.26-15.65, p = 0.02), pH less than 7.15 (OR 2.08; 95% CI 1.22-3.5, p = 0.007), worsening partial pressure of oxygen/fraction of inspired oxygen (OR 1.05; 95% CI 1.00-1.10, p = 0.04), and Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR 0.87; 95% CI 0.79-0.97, p = 0.009). Deep sedation was commonly administered when NMBs were not being used, with 99.2% of sedation-agitation scores of 1 or 2. Eighty-six patients (65.6%) received NMBs and use was greatest on day 1 (59.5%). Train-of-Four was measured every hour for 53.4% of patients; 29.2% of the measurements were 0 of 4. NMB use declined over the 10-year study period.
CONCLUSIONS: High analgo-sedation doses were associated with APACHE II scores, worsening gas exchange, and NMB use. Two thirds of patients received NMBs; use was highest on day 1 and subsequently declined. The percentage of patients who received NMB during HFOV in our study was lower than that previously reported. Future research should evaluate patient outcomes with and without use of NMBs, as well as the potential to manage patients with less sedation.
Lisa D Burry; Katherine Seto; Louise Rose; Stephanie C Lapinsky; Sangeeta Mehta
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  47     ISSN:  1542-6270     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-11-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1122-9     Citation Subset:  IM    
Department of Pharmacy, Mount Sinai Hospital, New York, NY.
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