title: The 90% effective dose of a sufentanil bolus for the management of painful positioning in intubated patients in the ICU.
abstract: BACKGROUND
  Pain and discomfort arising from the routine care of intubated patients in the ICU is managed by continuous infusion of narcotic and sedative drugs. There is benefit in keeping infusion rates low because lightening sedation improves clinical outcome, but this risks breakthrough pain. Management of this discomfort by bolus administration could permit lower background infusion rates, but the lowest effective bolus dose of sufentanil to achieve this is unknown.
  
  
  OBJECTIVE
  The aim of this study was to determine the effective analgesic dose in 90% of intubated patients (ED90) in the ICU given bolus sufentanil. Pain was assessed using a Behavioural Pain Scale (BPS) requiring a score of 3-4 during moving to the lateral decubitus position.
  
  
  METHODS
  Prospective, dose response study.
  
  
  METHODS
  A 16-bed multidisciplinary ICU in a French university hospital. Study period was from January to June 2010.
  
  
  METHODS
  Intubated and ventilated patients were eligible for the study once they had reached a BPS of 3 or 4 and Ramsay score of 3-5 within 48 h of admission to the ICU.
  
  
  METHODS
  The analgesic efficacy of a sufentanil bolus was measured during successive lateral decubitus positioning over a 72-h study period, using the BPS scale. The dose was increased with each subsequent turn to lateral decubitus until a BPS score of 3-4 was obtained (dose escalation, starting at zero).
  
  
  METHODS
  BPS, Ramsay score, heart rate and mean arterial pressure were collected before and during each procedure.
  
  
  RESULTS
  A total of 25 patients were enrolled over 6 months. The ED90 bolus for sufentanil was 0.15 μg kg, but 40% of the patients subsequently demonstrated increased BPS with this dose.
  
  
  CONCLUSIONS
  The effective dose in 90% was 0.15 μg kg during the first 5 days of sedation. There were no adverse effects. A pre-emptive sufentanil bolus can be used to treat anticipated pain in the ICU. Regular and frequent assessments of acute pain and sedation are essential for adjusting the dose, on a case-by-case basis. This strategy may help clinicians to keep background infusions of sedatives and narcotics as low as possible and may improve clinical outcome.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01356732.
authors.affiliation: Département d'Anesthésie et de Réanimation, CHU Toulouse, Université Toulouse III Paul Sabatier, Faculté de Médecine Toulouse-Rangueil, EA 4564-MATN, Institut Louis Bugnard, Toulouse, France. chaverondamien@yahoo.fr
authors.forename: Damien
authors.initials: D
authors.lastname: Chaveron
authors.forename: Stein
authors.initials: S
authors.lastname: Silva
authors.forename: Pascale
authors.initials: P
authors.lastname: Sanchez-Verlaan
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Conil
authors.forename: Agnès
authors.initials: A
authors.lastname: Sommet
authors.forename: Thomas
authors.initials: T
authors.lastname: Geeraerts
authors.forename: Michèle
authors.initials: M
authors.lastname: Génestal
authors.forename: Vincent
authors.initials: V
authors.lastname: Minville
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D016292:Procedural Sedation; D003422:Critical Care / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011187:Posture; D011446:Prospective Studies; D012121:Respiration, Artificial; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D017409:Sufentanil