[ICU-acquired neuromyopathy, delirium and sedation in intensive care unit].
ICU-acquired neuromyopathy (NMAR) and delirium are the two most frequent and severe neurological complications of intensive care medicine. Their mechanisms still remain to be elucidated. The objective of this review is to address the potential role of sedation in occurrence of these complications. There is no evidence that sedation is involved in NMARs. However, the hypothesis that muscle inactivity induced by sedation fosters NMAR is an argument to discontinue or reduce sedatives infusion whenever possible. It is also recommended not to administer propofol more than 48 h at an infusion rate above 5 mg/kg per hour in patients with systemic inflammatory response syndrome, because of the risk of propofol infusion syndrome, which includes notably rhabdomyolysis. The relationship between delirium and sedation are controversial because in most studies, patients were considered delirious though being still sedated and multivariate analysis was lacking. One study showed that lorazepam given continuously was an independent risk factor for daily transition to delirium 24 h later with a 20% increase risk of every unit dose (expressed as log(e)mg). The impact of deepness, daily interruption or titration of sedation on the prevalence of delirium has never been assessed but it seems that deep sedation has to be avoided.
Sharshar
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Service de réanimation, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France. tarek.sharshar@rpc.ap-hop-paris.fr
D016292:Procedural Sedation / Q000009:adverse effects; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000523:psychology / Q000628:therapy; D054810:Deep Sedation / Q000009:adverse effects*; D003693:Delirium / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D007103:Immobilization / Q000009:adverse effects / Q000523:psychology; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D009468:Neuromuscular Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000009:adverse effects; D012206:Rhabdomyolysis / Q000139:chemically induced; D012893:Sleep Wake Disorders / Q000139:chemically induced / Q000523:psychology; D009435:Synaptic Transmission / Q000187:drug effects; D013577:Syndrome
D006993:Hypnotics and Sedatives; D015742:Propofol