title: [Pain, agitation and delirium in acute respiratory failure].
abstract: Avoiding pain, agitation and delirium as well as avoiding unnecessary deep sedation is a powerful yet challenging strategy in critical care medicine. A number of interactions between cerebral function and respiratory function should be regarded in patients with respiratory failure and mechanical ventilation. A cooperative sedation strategy (i.e. patient is awake and free of pain and delirium) is feasible in many patients requiring invasive mechanical ventilation. Especially patients with mild acute respiratory distress syndrome (ARDS) seem to benefit from preserved spontaneous breathing. While completely disabling spontaneous ventilation with or without neuromuscular blockade is not a standard strategy in ARDS, it might be temporarily required in patients with severe ARDS, who have substantial dyssynchrony or persistent hypoxaemia. Since pain, agitation and delirium compromise respiratory function they should also be regarded during noninvasive ventilation and during ventilator weaning. Pharmacological sedation can have favourable effects in these situations, but should not be given routinely or uncritically.
authors.affiliation: I. Interne Lungenabteilung mit Intensivstation, Otto Wagner Spital, Sanatoriumstrasse 2, 1140, Wien, Österreich. georg-christian.funk@meduniwien.ac.at.
authors.forename: G-C
authors.initials: GC
authors.lastname: Funk
mesh_terms: D003131:Combined Modality Therapy / Q000379:methods; D016292:Procedural Sedation / Q000379:methods; D003422:Critical Care / Q000379:methods*; D003693:Delirium / Q000628:therapy*; D006801:Humans; D019148:Neuromuscular Blockade / Q000379:methods; D059408:Pain Management / Q000379:methods*; D011595:Psychomotor Agitation / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D015300:Ventilator Weaning / Q000379:methods
keywords: ARDS, human; Chronic obstructive pulmonary disease; Conscious sedation; Dyspnea; Ventilation
references.citation: Crit Care. 2012 Dec 12;16(2):217
references.pmid: 22429840
references.citation: Intensive Care Med. 2015 Dec;41(12):2130-7
references.pmid: 26404392
references.citation: Anaesth Intensive Care. 2010 Jan;38(1):82-90
references.pmid: 20191782
references.citation: Am J Respir Crit Care Med. 2011 Feb 1;183(3):364-71
references.pmid: 20813887
references.citation: Curr Opin Crit Care. 2015 Feb;21(1):26-33
references.pmid: 25517889
references.citation: Am J Respir Crit Care Med. 1999 Apr;159(4 Pt 1):1241-8
references.pmid: 10194172
references.citation: Eur Respir J. 2014 Jun;43(6):1750-62
references.pmid: 24525437
references.citation: Chest. 2014 Jun;145(6):1204-1212
references.pmid: 24577019
references.citation: Cochrane Database Syst Rev. 2004;(3):CD004104
references.pmid: 15266518
references.citation: Intern Med. 2012;51(17):2299-305
references.pmid: 22975538
references.citation: Lung. 2012 Dec;190(6):597-603
references.pmid: 22782122
references.citation: Multidiscip Respir Med. 2014 Nov 04;9(1):56
references.pmid: 25699177
references.citation: Crit Care Med. 2012 May;40(5):1578-85
references.pmid: 22430241
references.citation: Eur Respir J. 2007 May;29(5):1033-56
references.pmid: 17470624
references.citation: Crit Care Clin. 1999 Jan;15(1):151-66, vii
references.pmid: 9929792
references.citation: Crit Care Med. 2013 Jan;41(1):263-306
references.pmid: 23269131
references.citation: Intensive Care Med. 2015 Sep;41(9):1688-91
references.pmid: 26149300
references.citation: N Engl J Med. 2006 Apr 27;354(17):1775-86
references.pmid: 16641394
references.citation: Crit Care. 2001 Aug;5(4):221-6
references.pmid: 11511336
references.citation: Indian J Crit Care Med. 2014 Jul;18(7):431-6
references.pmid: 25097355
references.citation: Crit Care Med. 2013 Sep;41(9 Suppl 1):S39-45
references.pmid: 23989094
references.citation: Crit Care. 2009;13(3):R75
references.pmid: 19454032
references.citation: Am J Respir Crit Care Med. 1999 Jul;160(1):50-6
references.pmid: 10390379
references.citation: N Engl J Med. 2010 Sep 16;363(12):1107-16
references.pmid: 20843245
references.citation: Intensive Care Med. 2015 Dec;41(12):2201-3
references.pmid: 26399892
references.citation: Curr Ther Res Clin Exp. 2010 Jun;71(3):141-53
references.pmid: 24683260
references.citation: Chest. 2015 Nov;148(5):1231-1241
references.pmid: 26158245
references.citation: Crit Care. 2014 Jul 21;18(4):R156
references.pmid: 25047960
references.citation: Crit Care Med. 2013 Feb;41(2):536-45
references.pmid: 23263584
references.citation: Am J Crit Care. 2014 Jul;23(4):306-14; quiz 315
references.pmid: 24986171
references.citation: Intensive Care Med. 2015 Sep;41(9):1586-600
references.pmid: 25971392
references.citation: Respir Care. 2006 May;51(5):492-6
references.pmid: 16638158
references.citation: Lancet. 2008 Jan 12;371(9607):126-34
references.pmid: 18191684
references.citation: J Clin Pharm Ther. 2008 Feb;33(1):25-30
references.pmid: 18211613