A comparison of hypnotic and analgesic based sedation in a general intensive care unit.
BACKGROUND
Sedation of the critically ill patient has several components including hypnosis and analgesia. Hypnotic-based sedation (HBS), where midazolam and/or propofol are used, with morphine or another analgesic added as needed has been common. The advent of remifentanil has allowed greater use of analgesia-based sedation (ABS) where relief of discomfort from the tracheal tube or pain are the important objectives, and hypnosis is given as necessary. Method. We compared HBS and ABS (remifentanil-based sedation) within a general intensive care unit (ICU). During the first study period of 12 weeks, 111 patients received HBS. After the development of new guidelines for the use of remifentanil in the ICU, a second 12 week study period used an analgesia-based regimen, with hypnotics added only if needed.


RESULTS
Ninety-six patients received ABS, and 79 received remifentanil. It was possible to manage 29 (37%) of the patients receiving remifentanil without the use of supplementary hypnotic agents. In the remaining 63% the use of remifentanil was associated with a reduction in the amount and duration of propofol used. Significantly more patients receiving ABS had satisfactory levels of sedation during synchronized intermittent mandatory ventilation (19 [2,55] vs 50 [14,83], P<0.001).


CONCLUSIONS
The use of ABS allowed patients to be managed more comfortably, either without a hypnotic drug or with less hypnotic drug, than using conventional HBS.
Park
G
G
John Farman Intensive Care Unit, Addenbrooke's Hospital Hills Road, Cambridge CB2 2QQ, UK. gilbertpark@doctors.org.uk
Lane
M
M
Rogers
S
S
Bassett
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods*; D003422:Critical Care / Q000379:methods; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D015742:Propofol / Q000008:administration & dosage; D000077208:Remifentanil; D012121:Respiration, Artificial
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D008874:Midazolam; D015742:Propofol