title: Sedation in the critically ill ventilated patient: possible role of enteral drugs.
abstract: OBJECTIVE
  Sedation by the enteral route is unusual in intensive medicine. We analysed the feasibility/efficacy of long-term enteral sedation in ventilated critically ill patients.
  
  
  METHODS
  Prospective interventional cohort study.
  
  
  METHODS
  General ICU.
  
  
  METHODS
  Forty-two patients needing ventilation and sedation for at least 4 days.
  
  
  METHODS
  At admission, sedation was induced with propofol or midazolam. Enteral hydroxyzine (+/- enteral lorazepam) was added in all patients within the second day. Intravenous drugs were gradually withdrawn, trying to maintain only enteral sedation after the initial 48 h. Analgesia was provided with continuous IV fentanyl.
  
  
  RESULTS
  Sedation level was assessed evaluating, on a daily basis, patients' compliance to the invasive care and comparing observed vs planned Ramsay scores three times a day. Excluding the first 2 days of patient-stabilisation and fast titration of sedation level, 577 days with ventilatory support were analysed. In 460 days (79.7%) total enteral sedation was given. This percentage rose to 94.2% when the requested Ramsay was 2 (347 days). Daily sedation was judged as adequate in 82.8% of days of total enteral sedation. Thirty-one patients had total enteral as the exclusive route of sedation.
  
  
  CONCLUSIONS
  After 24-48 h, enteral sedation may replace, totally/in part, IV sedation in ventilated patients. Total enteral sedation easily fits the target when a Ramsay score 2 is planned. When a deeper sedation is needed, a mixed regimen is effective and lowers IV drug dosages. No side effects were reported.
authors.affiliation: Istituto di Anestesiologia e Rianimazione dell'Università degli Studi di Milano, Azienda Ospedaliera-Polo Universitario San Paolo, Italy. marcocigada@yahoo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Cigada
authors.forename: Angelo
authors.initials: A
authors.lastname: Pezzi
authors.forename: Piero
authors.initials: P
authors.lastname: Di Mauro
authors.forename: Silvia
authors.initials: S
authors.lastname: Marzorati
authors.forename: Andrea
authors.initials: A
authors.lastname: Noto
authors.forename: Federico
authors.initials: F
authors.lastname: Valdambrini
authors.forename: Matteo
authors.initials: M
authors.lastname: Zaniboni
authors.forename: Morena
authors.initials: M
authors.lastname: Astori
authors.forename: Gaetano
authors.initials: G
authors.lastname: Iapichino
mesh_terms: D000284:Administration, Oral; D000701:Analgesics, Opioid; D016292:Procedural Sedation / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D012121:Respiration, Artificial; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D006919:Hydroxyzine; D008140:Lorazepam; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol