‘Cooperative Sedation’: Optimizing Comfort while Maximizing Systemic and Neurological Function

  • H. E. Goodwin
  • J. J. LewinIII
  • M. A. Mirski
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM, volume 2012)

Abstract

Common indications for sedation in the intensive care unit (ICU) include patient comfort, management of agitation, pain, ventilator dysynchrony, and intracranial hypertension. Current trends in ICU care, however, have shifted towards sedation strategies that provide the minimally effective amount of sedation, to improve patient autonomy and preserve both the neurological exam and neurocognitive function.

Keywords

Bispectral Index Spontaneous Breathing Trial Mini Mental State Exam Sedation Scale Intensive Care Unit Care 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hopkins RO, Brett S (2005) Chronic neurocognitive effects of critical illness. Curr Opin Crit Care 11: 369–375PubMedCrossRefGoogle Scholar
  2. 2.
    Newman MF, Kirchner JL, Phillips-Bute B, et al (2001) Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 344: 395–402PubMedCrossRefGoogle Scholar
  3. 3.
    Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-Lohr V (1999) Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 160: 50–56PubMedCrossRefGoogle Scholar
  4. 4.
    Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342: 1471–1477PubMedCrossRefGoogle Scholar
  5. 5.
    Girard TD, Kress JP, Fuchs BD, et al (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. Lancet 371: 126–134PubMedCrossRefGoogle Scholar
  6. 6.
    Strom T, Martinussen T, Toft P (2010) A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomized trial. Lancet 375: 475–480PubMedCrossRefGoogle Scholar
  7. 7.
    Jackson JC, Hart RP, Gordon SM, Hopkins RO, Girard TD, Ely EW (2007) Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem. Crit Care 11: R27PubMedCrossRefGoogle Scholar
  8. 8.
    Kress JP, Gehlback B, Lacy M, Pliskin N, Pohlman AS, Hall JB (2003) The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med 168: 1457–1461PubMedCrossRefGoogle Scholar
  9. 9.
    Rochester CL (2009) Rehabilitation in the intensive care unit. Semin Respir Crit Care Med 30: 656–669PubMedCrossRefGoogle Scholar
  10. 10.
    Herridge MS, Cheung AM, Tansey CM, et al (2003) One year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348: 683–693PubMedCrossRefGoogle Scholar
  11. 11.
    Bailey P, Thomsen GE, Spuhler VJ, et al (2007) Early activity is feasible and safe in respiratory failure patients. Crit Care Med 35: 139–145PubMedCrossRefGoogle Scholar
  12. 12.
    Thomsen GE, Snow GL, Rodriguez L, Hopkins RO (2008) Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med 36: 1119–1124PubMedCrossRefGoogle Scholar
  13. 13.
    Morris PE, Goad A, Thompson C, et al (2008) Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 36: 2238–2243PubMedCrossRefGoogle Scholar
  14. 14.
    Schweikert WD, Pohlman MC, Pohlman AS, et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized controlled trial. Lancet 373: 1874–1882CrossRefGoogle Scholar
  15. 15.
    Mirski MA, Lewin JJ, LeDroux S, et al (2010) Cognitive improvement during continuous sedation in critically ill, awake and responsive patients: the Acute Neurological ICU Sedation Trial (ANIST). Intensive Care Med 36: 1505–1513PubMedCrossRefGoogle Scholar
  16. 16.
    Sessler CN, Gosnell MS, Grap MJ, et al (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166: 1338–1344PubMedCrossRefGoogle Scholar
  17. 17.
    Ely EW, Truman B, Shintani A, et al (2003) Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 289: 2983–2991PubMedCrossRefGoogle Scholar
  18. 18.
    Riker RR, Picard JT, Fraser GL (1999) Prospective evaluation of the Sedation-Agitation Scale for the adult critically ill patients. Crit Care Med 27: 1325–1329PubMedCrossRefGoogle Scholar
  19. 19.
    Devlin JW, Boleski G, Mlynarek M, et al (1999) Motor Activity Assessment Scale: avalid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med 27: 1271–1275PubMedCrossRefGoogle Scholar
  20. 20.
    De Jonghe B, Cook D, Griffith L, et al (2003) Adaptation to the intensive care environment (ATICE): development and validation of a new sedation assessment instrument. Crit Care Med 31: 2344–2354PubMedCrossRefGoogle Scholar
  21. 21.
    Mirski MA, LeDroux SN, Lewin JJ, Thompson CB, Mirski KT, Griswold M. (2010) Validity and reliability of an intuitive conscious sedation scoring tool: The nursing instrument for the communication of sedation. Crit Care Med 38: 1674–1684PubMedCrossRefGoogle Scholar
  22. 22.
    Myles PS, Leslie K, McNeil J, et al (2004) Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomized controlled trial. Lancet 363: 1757–1763PubMedCrossRefGoogle Scholar
  23. 23.
    Deogaonkar A, Gupta R, DeGorgia M, et al (2004) Bispectral index monitoring correlates with sedation scales in brain-injured patients. Crit Care Med 32: 2403–2406PubMedCrossRefGoogle Scholar
  24. 24.
    Olson DM, Thoyre SM, Peterson ED, Graffagnino C. (2009) A randomized evaluation of bispectral index-augmented sedation assessment in neurological patients. Neurocrit Care 11: 20–27PubMedCrossRefGoogle Scholar
  25. 25.
    Riker RR, Fraser GL, Simmons LE, Wilkins ML (2001) Validating the sedation-agitation scale with the bispectral index and visual analog scale in adult ICU patients after cardiac surgery. Intensive Care Med 27: 853–858PubMedCrossRefGoogle Scholar
  26. 26.
    Karachandani K, Rewari V, Trikha A, Batra RK (2010) Bispectral index correlates well with Richmond agitation sedation scale in mechanically ventilated critically ill patients. J Anesth 24: 394–398CrossRefGoogle Scholar
  27. 27.
    Ely EW, Margolin R, Francis J, et al (2001) Evaluation of delirium in critically ill patients: validation of the confusion assessment method for the intensive care unit (CAM-ICU). Crit Care Med 29: 1370–1379PubMedCrossRefGoogle Scholar
  28. 28.
    Ely EW, Inouye SK, Bernard GR, et al (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286: 2703–2710PubMedCrossRefGoogle Scholar
  29. 29.
    Ely WE, Shintani A, Truman B, et al (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291: 1753–1762PubMedCrossRefGoogle Scholar
  30. 30.
    Thomason JWW, Shintani A, Peterson JF, Pun BT, Jackson JC, Ely WE (2005) Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients. Crit Care 9: R375–R381PubMedCrossRefGoogle Scholar
  31. 31.
    Ouimet S, Riker R, Bergeron N, Cossette M, Kavanagu B, Skrobik Y (2007) Subsyndromal delirium in the ICU: evidence for a disease spectrum. Intensive Care Med 33: 1007–1013PubMedCrossRefGoogle Scholar
  32. 32.
    Folstein MF, Folstein SE, McHugh PR (1975) Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 12: 189–198PubMedCrossRefGoogle Scholar
  33. 33.
    Lewin JJ, LeDroux SN, Shermock KM, et al (2012) Validity and reliability of The Johns Hopkins Adapted Cognitive Exam for critically ill patients. Crit Care Med 40: 139–144PubMedCrossRefGoogle Scholar
  34. 34.
    Mirski MA, Lewin JJ (2007) Sedation and analgesia for the critically ill patient. Contemp Crit Care 4: 1–12Google Scholar
  35. 35.
    Pandharipande PP, Pun BT, Herr DL, et al (2007) Effect of sedation with dexemedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 298: 2644–2653PubMedCrossRefGoogle Scholar
  36. 36.
    Riker RR, Shehabi Y, Bokesch PM, et al (2009) Dexmedetomidine vs midazolam for sedation of critically ill patients. JAMA 301: 489–499PubMedCrossRefGoogle Scholar
  37. 37.
    Pisani MA, Murphy TE, Araujo KL, Slattum P, Van Ness PH, Inouye SK (2009) Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. Crit Care Med 37: 177–183PubMedCrossRefGoogle Scholar
  38. 38.
    Mehta S, Burry L, Fischer S, et al (2006) Canadian survey of the use of sedatives, analgesics, and neuromuscular blocking agents in critically ill patients. Crit Care Med 34: 374–380PubMedCrossRefGoogle Scholar
  39. 39.
    O’Connor M, Bucknall T, Manias E (2010) Sedation management in Australian and New Zealand intensive care units: doctors’ and nurses’ practices and opinions. Am J Crit Care 19: 285–295CrossRefGoogle Scholar
  40. 40.
    Salluh JIF, Dal-Pizzol F, Mello PVC, et al (2009) Delirium recognition and sedation practices in critically ill patients: a survey on the attitudes of 1015 Brazilian critical care physicians. J Crit Care 24: 556–562PubMedCrossRefGoogle Scholar
  41. 41.
    Tanios MA, de Wit M, Epstein SK, Devlin JW (2009) Preceived barriers to the use of sedation protocols and daily interruptions: a multidisciplinary survey. J Crit Care 24: 66–73PubMedCrossRefGoogle Scholar
  42. 42.
    Guttormson JL, Chlan L, Weinert C, Savik K (2010) Factors influencing nurse sedation practices with mechanically ventilated patients: a US national survey. Intensive Crit Care Nurs 26: 44–50PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • H. E. Goodwin
  • J. J. LewinIII
  • M. A. Mirski

There are no affiliations available

Personalised recommendations