title: Epidural analgesia in the intensive care unit: An observational series of 121 patients.
abstract: BACKGROUND
  Epidural analgesia (EA) has been more investigated during the perioperative period than in the intensive care unit (ICU) setting. Recent studies support beneficial effects for EA beyond analgesia itself. However, data on feasibility and safety are still lacking in the ICU. Our goal was to assess the feasibility and practice of EA in ICU patients.
  
  
  METHODS
  Multicentre observational study in 3 ICUs over a 10-month period. Goals were to report the incidence of EA-related complications and EA duration. All ICU patients receiving EA were included, whether EA was initiated in the ICU or elsewhere, e.g. in the operating room. Demographics, clinical and biological data were prospectively recorded. Epidural catheter tips were sent to the microbiology laboratory for culture.
  
  
  RESULTS
  One hundred and twenty-one patients were included (mean age 60 years), with mean SOFA and median SAPS II scores of 3.2 and 32, respectively. Reasons for EA initiation included trauma (14%), postoperative pain management after major surgery (42%), and pancreatitis (31%). No EA-related neurologic complication was recorded, and one case of epidural abscess is discussed. No other EA-related infectious complications were observed. Median duration of EA was 11 days. Reasons for EA discontinuation included efficient analgesia without EA (60%) and accidental catheter removal (17%). 22% of epidural catheter cultures were positive for skin flora bacteria.
  
  
  CONCLUSIONS
  EA seems feasible in the ICU. Its apparent safety should be further validated in larger cohorts, but these preliminary results may stimulate more interest in the assessment of potential benefits associated with EA in the ICU setting.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Estaing University Hospital, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; R2D2 (Retinoids, Reproduction and Developmental Diseases)-EA 7281, School of Medicine, Université d'Auvergne Clermont-Ferrand 1, 63000 Clermont-Ferrand, France. Electronic address: mjabaudon@chu-clermontferrand.fr.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Jabaudon
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Gabriel-Montpied University Hospital, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
authors.forename: Russell
authors.initials: R
authors.lastname: Chabanne
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Emile-Roux Hospital, 43000 Le Puy-en-Velay, France.
authors.forename: Achille
authors.initials: A
authors.lastname: Sossou
authors.affiliation: Intensive Care Unit, Cannes General Hospital, 06414 Cannes, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Bertrand
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Gabriel-Montpied University Hospital, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Kauffmann
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Estaing University Hospital, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Chartier
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Estaing University Hospital, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Guérin
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Gabriel-Montpied University Hospital, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Imhoff
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Emile-Roux Hospital, 43000 Le Puy-en-Velay, France.
authors.forename: Lassane
authors.initials: L
authors.lastname: Zanre
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Emile-Roux Hospital, 43000 Le Puy-en-Velay, France.
authors.forename: François
authors.initials: F
authors.lastname: Brénas
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Estaing University Hospital, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
authors.forename: Jean-Etienne
authors.initials: JE
authors.lastname: Bazin
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit, Estaing University Hospital, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; R2D2 (Retinoids, Reproduction and Developmental Diseases)-EA 7281, School of Medicine, Université d'Auvergne Clermont-Ferrand 1, 63000 Clermont-Ferrand, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Constantin
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D057785:Catheters / Q000382:microbiology; D003422:Critical Care / Q000379:methods*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000628:therapy; D010195:Pancreatitis / Q000150:complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy
keywords: Epidural analgesia; Epidural complications; Feasibility; Intensive care unit