Sedative and analgesic medications: Risk factors for delirium and sleep disturbances in the critically ill

被引:109
作者
Pandharipande, Pratik
Ely, E. Wesley
机构
[1] Vanderbilt Univ, Sch Med, Div Crit Care, Dept Anesthesiol, Nashville, TN 37232 USA
[2] Vanderbilt Univ, Sch Med, Dept Med, Ctr Hlth Serv Res, Nashville, TN 37232 USA
[3] Vanderbilt Univ, Sch Med, Div Allergy Pulm Crit Care Med, Nashville, TN 37232 USA
[4] Vet Adm Tennessee Valley Geriatr Res, Educ & Clin Ctr, Nashville, TN 37232 USA
关键词
D O I
10.1016/j.ccc.2006.02.010
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Sedatives and analgesics are routinely used in critically ill patients, although they have the potential for side effects, such as delirium and sleep architecture disruption. Although it should be emphasized that these medications are extremely important in providing patient comfort, health care professionals must also strive to achieve the right balance of sedative and analgesic administration through greater focus on reducing unnecessary or overzealous use. Ongoing clinical trials should help us to understand whether altering the delivery strategy, via daily sedation interruption, or protocolized target-based sedation or changing sedation paradigms to target different central nervous system receptors can affect cognitive outcomes and sleep preservation in our critically ill patients.
引用
收藏
页码:313 / +
页数:16
相关论文
共 84 条
[11]   Sleep disruption in critically ill patients - pharmacological considerations [J].
Bourne, RS ;
Mills, GH .
ANAESTHESIA, 2004, 59 (04) :374-384
[12]   Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation [J].
Brook, AD ;
Ahrens, TS ;
Schaiff, R ;
Prentice, D ;
Sherman, G ;
Shannon, W ;
Kollef, MH .
CRITICAL CARE MEDICINE, 1999, 27 (12) :2609-2615
[13]  
Comarow Avery, 2004, US News World Rep, V137, P83
[14]   Sleep in critically ill patients requiring mechanical ventilation [J].
Cooper, AB ;
Thornley, KS ;
Young, GB ;
Slutsky, AS ;
Stewart, TE ;
Hanly, PJ .
CHEST, 2000, 117 (03) :809-818
[15]  
Crippen D., 2001, VENTILATOR MANAGEMEN, P243
[16]   Pharmacokinetics and pharmacodynamics of inhaled versus intravenous morphine in healthy volunteers [J].
Dershwitz, M ;
Walsh, JL ;
Morishige, RJ ;
Conners, PM ;
Rubsamen, RM ;
Shafer, SL ;
Rosow, CE .
ANESTHESIOLOGY, 2000, 93 (03) :619-628
[17]   Delirium in an intensive care unit: a study of risk factors [J].
Dubois, MJ ;
Bergeron, N ;
Dumont, M ;
Dial, S ;
Skrobik, Y .
INTENSIVE CARE MEDICINE, 2001, 27 (08) :1297-1304
[18]   Monitoring sedation status over time in ICU patients - Reliability and validity of the Richmond Agitation-Sedation Scale (RASS) [J].
Ely, EW ;
Truman, B ;
Shintani, A ;
Thomason, JWW ;
Wheeler, AP ;
Gordon, S ;
Francis, J ;
Speroff, T ;
Gautam, S ;
Margolin, R ;
Sessler, CN ;
Dittus, RS ;
Bernard, GR .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2003, 289 (22) :2983-2991
[19]   Delirium in mechanically ventilated patients - Validity and reliability of the Confusion Assessment Method for the intensive care unit (CAM-ICU) [J].
Ely, EW ;
Inouye, SK ;
Bernard, GR ;
Gordon, S ;
Francis, J ;
May, L ;
Truman, B ;
Speroff, T ;
Gautam, S ;
Margolin, R ;
Hart, RP ;
Dittus, R .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 286 (21) :2703-2710
[20]   Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) [J].
Ely, EW ;
Margolin, R ;
Francis, J ;
May, L ;
Truman, B ;
Dittus, R ;
Speroff, T ;
Gautam, S ;
Bernard, GR ;
Inouye, SK .
CRITICAL CARE MEDICINE, 2001, 29 (07) :1370-1379