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Sedation

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Acute Respiratory Distress Syndrome

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Abstract

Sedation is of paramount importance in the management of ARDS. Supporting the vital functions in the acute phase of acute respiratory failure management requires analgesic and tranquilizing drugs, both to permit the invasive procedures with the lowest iatrogenic damage and to control the body stress response.

Once clinical stabilization is obtained, the available scientific evidences underline the importance of managing pain, agitation, and delirium symptoms, while maintaining the mildest possible level of sedation. Compliance to mechanical ventilation, anxiety and agitation control, and oxygen consumption decrease are possible reasons to explain the role of sedative therapy in decreasing mortality and morbidity. Thus, sedation should aim to provide the best possible adaptation to the critical illness yet avoiding excessive unconsciousness or prolonged ICU stay. In this context, the key intervention is maintaining a continuous pain/agitation/delirium monitoring using validated tools to early manage the arising neurological dysfunctions according to locally agreed protocols. Careful neurologic monitoring is even more important than the choice of a particular sedative agent itself since the literature supports modest differences in outcomes by using non-benzodiazepine-based sedation protocols.

At a later stage, during the mechanical ventilation weaning, implementing early physical mobilization, as well as the family engagement, should be considered along with the earliest sedation interruption and the continuous monitoring and management of pain, agitation, and delirium.

Adoption of local sedation protocols is strongly advised by the most recent literature. They could be comprehensive of the daily interruption of short-term sedatives (propofol, dexmedetomidine), the analgesia-based sedation (morphine, fentanyl, or remifentanil), the use of inhalational halogenated in the earlier phase (sevoflurane), or the use of enteral approach during the subsequent phases. Whichever the local protocol, the international guidelines point out the necessity to keep patients “awake and cooperative” as soon as possible, then avoiding the iatrogenic risks of both under- and oversedation.

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References

  1. Sessler CN, Varney K (2008) Patient-focused sedation and analgesia in the ICU. Chest 133(2):552–565. doi:10.1378/chest.07-2026

    Article  CAS  PubMed  Google Scholar 

  2. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW (2013) Long-term cognitive impairment after critical illness. N Engl J Med 369(14):1306–1316. doi:10.1056/NEJMoa1301372

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Fraser GL, Riker RR (2007) Sedation and analgesia in the critically ill adult. Curr Opin Anaesthesiol 20(2):119–123. doi:10.1097/ACO.0b013e32808255b4

    Article  PubMed  Google Scholar 

  4. Baron R, Binder A, Biniek R, Braune S, Buerkle H, Dall P, Demirakca S, Eckardt R, Eggers V, Eichler I, Fietze I, Freys S, Frund A, Garten L, Gohrbandt B, Harth I, Hartl W, Heppner HJ, Horter J, Huth R, Janssens U, Jungk C, Kaeuper KM, Kessler P, Kleinschmidt S, Kochanek M, Kumpf M, Meiser A, Mueller A, Orth M, Putensen C, Roth B, Schaefer M, Schaefers R, Schellongowski P, Schindler M, Schmitt R, Scholz J, Schroeder S, Schwarzmann G, Spies C, Stingele R, Tonner P, Trieschmann U, Tryba M, Wappler F, Waydhas C, Weiss B, Weisshaar G (2015) Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version. Ger Med Sci GMS E-Journal 13:Doc19. doi:10.3205/000223

    PubMed  Google Scholar 

  5. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 41(1):263–306. doi:10.1097/CCM.0b013e3182783b72

    Article  PubMed  Google Scholar 

  6. Celis-Rodriguez E, Birchenall C, de la Cal MA, Castorena Arellano G, Hernandez A, Ceraso D, Diaz Cortes JC, Duenas Castell C, Jimenez EJ, Meza JC, Munoz Martinez T, Sosa Garcia JO, Pacheco Tovar C, Palizas F, Pardo Oviedo JM, Pinilla DI, Raffan-Sanabria F, Raimondi N, Righy Shinotsuka C, Suarez M, Ugarte S, Rubiano S (2013) Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients. Med Intensiva/Sociedad Espanola de Medicina Intensiva y Unidades Coronarias 37(8):519–574. doi:10.1016/j.medin.2013.04.001

    Article  CAS  Google Scholar 

  7. Ice CJ, Personett HA, Frazee EN, Dierkhising RA, Kashyap R, Oeckler RA (2016) Risk factors for dexmedetomidine-associated hemodynamic instability in noncardiac intensive care unit patients. Anesth Analg 122(2):462–469. doi:10.1213/ANE.0000000000001125

    Article  CAS  PubMed  Google Scholar 

  8. Nseir S, Makris D, Mathieu D, Durocher A, Marquette CH (2010) Intensive care unit-acquired infection as a side effect of sedation. Crit Care 14(2):R30

    Article  PubMed  PubMed Central  Google Scholar 

  9. 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(1):177–183. doi:10.1097/CCM.0b013e318192fcf9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Jackson DL, Proudfoot CW, Cann KF, Walsh T (2010) A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety. Crit Care 14(2):R59. doi:10.1186/cc8956

    Article  PubMed  PubMed Central  Google Scholar 

  11. Riker RR, Fraser GL (2005) Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit. Pharmacotherapy 25(5 Pt 2):8S–18S

    Article  CAS  PubMed  Google Scholar 

  12. Cigada M, Corbella D, Mistraletti G, Forster CR, Tommasino C, Morabito A, Iapichino G (2008) Conscious sedation in the critically ill ventilated patient. J Crit Care 23(3):349–353. doi:10.1016/j.jcrc.2007.04.003

    Article  PubMed  Google Scholar 

  13. De Jonghe B, Bastuji-Garin S, Fangio P, Lacherade JC, Jabot J, Appere-De-Vecchi C, Rocha N, Outin H (2005) Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med 33(1):120–127

    Article  PubMed  Google Scholar 

  14. Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, McArthur C, Seppelt IM, Webb S, Weisbrodt L (2012) Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med 186(8):724–731. doi:10.1164/rccm.201203-0522OC

    Article  PubMed  Google Scholar 

  15. Shehabi Y, Chan L, Kadiman S, Alias A, Ismail WN, Tan MA, Khoo TM, Ali SB, Saman MA, Shaltut A, Tan CC, Yong CY, Bailey M (2013) Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study. Intensive Care Med 39(5):910–918. doi:10.1007/s00134-013-2830-2

    Article  PubMed  PubMed Central  Google Scholar 

  16. 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(20):1471–1477. doi:10.1056/NEJM200005183422002

    Article  CAS  PubMed  Google Scholar 

  17. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW (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 randomised controlled trial. Lancet 371(9607):126–134. doi:10.1016/S0140-6736(08)60105-1

    Article  PubMed  Google Scholar 

  18. Breen D, Karabinis A, Malbrain M, Morais R, Albrecht S, Jarnvig IL, Parkinson P, Kirkham AJ (2005) Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: a randomised trial [ISRCTN47583497]. Crit Care 9(3):R200–R210. doi:10.1186/cc3495

    Article  PubMed  PubMed Central  Google Scholar 

  19. Spies C, Macguill M, Heymann A, Ganea C, Krahne D, Assman A, Kosiek HR, Scholtz K, Wernecke KD, Martin J (2011) A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients. Intensive Care Med 37(3):469–476. doi:10.1007/s00134-010-2100-5

    Article  CAS  PubMed  Google Scholar 

  20. Tan JA, Ho KM (2009) Use of remifentanil as a sedative agent in critically ill adult patients: a meta-analysis. Anaesthesia 64(12):1342–1352. doi:10.1111/j.1365-2044.2009.06129.x

    Article  CAS  PubMed  Google Scholar 

  21. Strom T, Martinussen T, Toft P (2010) A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 375(9713):475–480. doi:10.1016/S0140-6736(09)62072-9

    Article  PubMed  Google Scholar 

  22. Chevron V, Menard JF, Richard JC, Girault C, Leroy J, Bonmarchand G (1998) Unplanned extubation: risk factors of development and predictive criteria for reintubation. Crit Care Med 26(6):1049–1053

    Article  CAS  PubMed  Google Scholar 

  23. Guttormson JL, Chlan L, Weinert C, Savik K (2010) Factors influencing nurse sedation practices with mechanically ventilated patients: a U.S. national survey. Intensive Crit Care Nurs Off J Br Assoc Crit Care Nurses 26(1):44–50. doi:10.1016/j.iccn.2009.10.004

    Article  Google Scholar 

  24. Goodwin H, Lewin JJ, Mirski MA (2012) ‘Cooperative sedation’: optimizing comfort while maximizing systemic and neurological function. Crit Care 16(2):217. doi:10.1186/cc11231

    Article  PubMed  PubMed Central  Google Scholar 

  25. Martin J, Franck M, Fischer M, Spies C (2006) Sedation and analgesia in German intensive care units: how is it done in reality? Results of a patient-based survey of analgesia and sedation. Intensive Care Med 32(8):1137–1142. doi:10.1007/s00134-006-0214-6

    Article  PubMed  Google Scholar 

  26. Payen JF, Chanques G, Mantz J, Hercule C, Auriant I, Leguillou JL, Binhas M, Genty C, Rolland C, Bosson JL (2007) Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology 106 (4):687–695; quiz 891-682. doi:10.1097/01.anes.0000264747.09017.da

  27. Devlin JW (2008) The pharmacology of oversedation in mechanically ventilated adults. Curr Opin Crit Care 14(4):403–407. doi:10.1097/MCC.0b013e32830280b3

    Article  PubMed  Google Scholar 

  28. Mistraletti G, Mantovani ES, Cadringher P, Cerri B, Corbella D, Umbrello M, Anania S, Andrighi E, Barello S, Di Carlo A, Martinetti F, Formenti P, Spanu P, Iapichino G (2013) Enteral vs. intravenous ICU sedation management: study protocol for a randomized controlled trial. Trials 14:92. doi:10.1186/1745-6215-14-92

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Granja C, Gomes E, Amaro A, Ribeiro O, Jones C, Carneiro A, Costa-Pereira A (2008) Understanding posttraumatic stress disorder-related symptoms after critical care: the early illness amnesia hypothesis. Crit Care Med 36(10):2801–2809. doi:10.1097/CCM.0b013e318186a3e7

    Article  PubMed  Google Scholar 

  30. Robinson BR, Berube M, Barr J, Riker R, Gelinas C (2013) Psychometric analysis of subjective sedation scales in critically ill adults. Crit Care Med 41(9 Suppl 1):S16–S29. doi:10.1097/CCM.0b013e3182a16879

    Article  PubMed  Google Scholar 

  31. Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, Lavagne P, Jacquot C (2001) Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 29(12):2258–2263

    Article  CAS  PubMed  Google Scholar 

  32. Gelinas C, Fillion L, Puntillo KA, Viens C, Fortier M (2006) Validation of the critical-care pain observation tool in adult patients. Am J Crit Care Off Publ Am Assoc Crit-Care Nurses 15(4):420–427

    Google Scholar 

  33. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick RK (2002) The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 166(10):1338–1344. doi:10.1164/rccm.2107138

    Article  PubMed  Google Scholar 

  34. Riker RR, Picard JT, Fraser GL (1999) Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med 27(7):1325–1329

    Article  CAS  PubMed  Google Scholar 

  35. Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, Inouye SK (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(7):1370–1379

    Article  CAS  PubMed  Google Scholar 

  36. Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001) Intensive Care Delirium Screening Checklist: evaluation of a new screening tool. Intensive Care Med 27(5):859–864

    Article  CAS  PubMed  Google Scholar 

  37. Aissaoui Y, Zeggwagh AA, Zekraoui A, Abidi K, Abouqal R (2005) Validation of a behavioral pain scale in critically ill, sedated, and mechanically ventilated patients. Anesth Analg 101(5):1470–1476. doi:10.1213/01.ANE.0000182331.68722.FF

    Article  PubMed  Google Scholar 

  38. Ahlers SJ, van der Veen AM, van Dijk M, Tibboel D, Knibbe CA (2010) The use of the behavioral pain scale to assess pain in conscious sedated patients. Anesth Analg 110(1):127–133. doi:10.1213/ANE.0b013e3181c3119e

    Article  PubMed  Google Scholar 

  39. Pun BT, Gordon SM, Peterson JF, Shintani AK, Jackson JC, Foss J, Harding SD, Bernard GR, Dittus RS, Ely EW (2005) Large-scale implementation of sedation and delirium monitoring in the intensive care unit: a report from two medical centers. Crit Care Med 33(6):1199–1205

    Article  PubMed  Google Scholar 

  40. Morandi A, Pandharipande P, Trabucchi M, Rozzini R, Mistraletti G, Trompeo AC, Gregoretti C, Gattinoni L, Ranieri MV, Brochard L, Annane D, Putensen C, Guenther U, Fuentes P, Tobar E, Anzueto AR, Esteban A, Skrobik Y, Salluh JI, Soares M, Granja C, Stubhaug A, de Rooij SE, Ely EW (2008) Understanding international differences in terminology for delirium and other types of acute brain dysfunction in critically ill patients. Intensive Care Med 34(10):1907–1915. doi:10.1007/s00134-008-1177-6

    Article  CAS  PubMed  Google Scholar 

  41. Spronk PE, Riekerk B, Hofhuis J, Rommes JH (2009) Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med 35(7):1276–1280. doi:10.1007/s00134-009-1466-8

    Article  PubMed  PubMed Central  Google Scholar 

  42. Vasilevskis EE, Han JH, Hughes CG, Ely EW (2012) Epidemiology and risk factors for delirium across hospital settings. Best Pract Res Clin Anaesthesiol 26(3):277–287. doi:10.1016/j.bpa.2012.07.003

    Article  PubMed  PubMed Central  Google Scholar 

  43. Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH (2009) Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 180(11):1092–1097. doi:10.1164/rccm.200904-0537OC

    Article  PubMed  PubMed Central  Google Scholar 

  44. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA J Am Med Assoc 291(14):1753–1762. doi:10.1001/jama.291.14.1753

    Article  CAS  Google Scholar 

  45. Mistraletti G, Pelosi P, Mantovani ES, Berardino M, Gregoretti C (2012) Delirium: clinical approach and prevention. Best Pract Res Clin Anaesthesiol 26(3):311–326. doi:10.1016/j.bpa.2012.07.001

    Article  PubMed  Google Scholar 

  46. Devlin JW, Fong JJ, Schumaker G, O’Connor H, Ruthazer R, Garpestad E (2007) Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients. Crit Care Med 35 (12):2721–2724; quiz 2725

    Google Scholar 

  47. Strom T, Toft P (2011) Time to wake up the patients in the ICU: a crazy idea or common sense? Minerva Anestesiol 77(1):59–63

    CAS  PubMed  Google Scholar 

  48. Sessler CN, Grap MJ, Ramsay MA (2008) Evaluating and monitoring analgesia and sedation in the intensive care unit. Crit Care 12(Suppl 3):S2. doi:10.1186/cc6148

    Article  PubMed  PubMed Central  Google Scholar 

  49. Haenggi M, Ypparila-Wolters H, Buerki S, Schlauri R, Korhonen I, Takala J, Jakob SM (2009) Auditory event-related potentials, bispectral index, and entropy for the discrimination of different levels of sedation in intensive care unit patients. Anesth Analg 109(3):807–816. doi:10.1213/ane.0b013e3181acc85d

    Article  PubMed  Google Scholar 

  50. Walsh TS, Lapinlampi TP, Ramsay P, Sarkela MO, Uutela K, Viertio-Oja HE (2011) Responsiveness of the frontal EMG for monitoring the sedation state of critically ill patients. Br J Anaesth 107(5):710–718. doi:10.1093/bja/aer228

    Article  CAS  PubMed  Google Scholar 

  51. Mondello E, Siliotti R, Gravino E, Coluzzi F, David T, Sinardi AU (2005) Sedation monitoring in ICU. Minerva Anestesiol 71(9):487–496

    CAS  PubMed  Google Scholar 

  52. LeBlanc JM, Dasta JF, Pruchnicki MC, Gerlach A, Cook C (2012) Bispectral index values, sedation-agitation scores, and plasma Lorazepam concentrations in critically ill surgical patients. Am J Crit Care Off Publ Am Assoc Crit Care Nurses 21(2):99–105. doi:10.4037/ajcc2012777

    Google Scholar 

  53. Masica AL, Girard TD, Wilkinson GR, Thomason JW, Truman Pun B, Nair UB, Light RW, Canonico AE, Dunn J, Pandharipande P, Shintani AK, Ely EW (2007) Clinical sedation scores as indicators of sedative and analgesic drug exposure in intensive care unit patients. Am J Geriatr Pharmacother 5(3):218–231. doi:10.1016/j.amjopharm.2007.10.005

    Article  CAS  PubMed  Google Scholar 

  54. Mistraletti G, Taverna M, Sabbatini G, Carloni E, Bolgiaghi L, Pirrone M, Cigada M, Destrebecq AL, Carli F, Iapichino G (2009) Actigraphic monitoring in critically ill patients: preliminary results toward an “observation-guided sedation”. J Crit Care 24(4):563–567. doi:10.1016/j.jcrc.2009.05.006

    Article  PubMed  Google Scholar 

  55. Grap MJ, Hamilton VA, McNallen A, Ketchum JM, Best AM, Arief NY, Wetzel PA (2011) Actigraphy: analyzing patient movement. Heart Lung J Crit Care 40(3):e52–e59. doi:10.1016/j.hrtlng.2009.12.013

    Article  Google Scholar 

  56. Patel SB, Kress JP (2012) Sedation and analgesia in the mechanically ventilated patient. Am J Respir Crit Care Med 185(5):486–497. doi:10.1164/rccm.201102-0273CI

    Article  CAS  PubMed  Google Scholar 

  57. Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. Br Med J 2(5920):656–659

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Reschreiter H, Maiden M, Kapila A (2008) Sedation practice in the intensive care unit: a UK national survey. Crit Care 12(6):R152. doi:10.1186/cc7141

    Article  PubMed  PubMed Central  Google Scholar 

  59. De Jonghe B, Cook D, Appere-De-Vecchi C, Guyatt G, Meade M, Outin H (2000) Using and understanding sedation scoring systems: a systematic review. Intensive Care Med 26(3):275–285

    Article  CAS  PubMed  Google Scholar 

  60. McGrane S, Pandharipande PP (2012) Sedation in the intensive care unit. Minerva Anestesiol 78(3):369–380

    CAS  PubMed  Google Scholar 

  61. Mirski MA, LeDroux SN, Lewin JJ 3rd, 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(8):1674–1684. doi:10.1097/CCM.0b013e3181e7c73e

    Article  PubMed  Google Scholar 

  62. De Jonghe B, Cook D, Griffith L, Appere-de-Vecchi C, Guyatt G, Theron V, Vagnerre A, Outin H (2003) Adaptation to the Intensive Care Environment (ATICE): development and validation of a new sedation assessment instrument. Crit Care Med 31(9):2344–2354. doi:10.1097/01.CCM.0000084850.16444.94

    Article  PubMed  Google Scholar 

  63. Brush DR, Kress JP (2009) Sedation and analgesia for the mechanically ventilated patient. Clin Chest Med 30 (1):131–141, ix. doi:10.1016/j.ccm.2008.09.001

  64. Brown EN, Lydic R, Schiff ND (2010) General anesthesia, sleep, and coma. N Engl J Med 363(27):2638–2650. doi:10.1056/NEJMra0808281

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Girardis M, Cantaroni C, Savoia G, Melotti R, Conti G (2016) A critical appraisal of the quality of analgosedation guidelines in critically ill patients. Minerva Anestesiol 82(2):230–235

    PubMed  Google Scholar 

  66. Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, Shintani AK, Thompson JL, Jackson JC, Deppen SA, Stiles RA, Dittus RS, Bernard GR, Ely EW (2007) Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 298(22):2644–2653. doi:10.1001/jama.298.22.2644

    Article  CAS  PubMed  Google Scholar 

  67. Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG (2009) Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 301(5):489–499. doi:10.1001/jama.2009.56

    Article  CAS  PubMed  Google Scholar 

  68. Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, Bratty JR, Takala J (2012) Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 307(11):1151–1160. doi:10.1001/jama.2012.304

    Article  CAS  PubMed  Google Scholar 

  69. Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, McArthur C, Murray L, Seppelt IM, Webb S, Weisbrodt L (2013) Early goal-directed sedation versus standard sedation in mechanically ventilated critically ill patients: a pilot study*. Crit Care Med 41(8):1983–1991. doi:10.1097/CCM.0b013e31828a437d

    Article  CAS  PubMed  Google Scholar 

  70. Svenningsen H, Egerod I, Videbech P, Christensen D, Frydenberg M, Tonnesen EK (2013) Fluctuations in sedation levels may contribute to delirium in ICU patients. Acta Anaesthesiol Scand 57(3):288–293. doi:10.1111/aas.12048

    Article  CAS  PubMed  Google Scholar 

  71. Jones C, Griffiths RD, Humphris G, Skirrow PM (2001) Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 29(3):573–580

    Article  CAS  PubMed  Google Scholar 

  72. Mehta S, Burry L, Cook D, Fergusson D, Steinberg M, Granton J, Herridge M, Ferguson N, Devlin J, Tanios M, Dodek P, Fowler R, Burns K, Jacka M, Olafson K, Skrobik Y, Hebert P, Sabri E, Meade M (2012) Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA 308(19):1985–1992

    Article  CAS  PubMed  Google Scholar 

  73. Schweickert WD, Kress JP (2008) Strategies to optimize analgesia and sedation. Crit Care 12(Suppl 3):S6. doi:10.1186/cc6151

    Article  PubMed  PubMed Central  Google Scholar 

  74. Sessler CN, Pedram S (2009) Protocolized and target-based sedation and analgesia in the ICU. Crit Care Clin 25 (3):489–513, viii. doi:10.1016/j.ccc.2009.03.001

  75. Zhou Y, Jin X, Kang Y, Liang G, Liu T, Deng N (2014) Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study. Crit Care 18(3):R122. doi:10.1186/cc13922

    Article  PubMed  PubMed Central  Google Scholar 

  76. Samuelson KA, Lundberg D, Fridlund B (2008) Light vs. heavy sedation during mechanical ventilation after oesophagectomy–a pilot experimental study focusing on memory. Acta Anaesthesiol Scand 52(8):1116–1123. doi:10.1111/j.1399-6576.2008.01702.x

    Article  CAS  PubMed  Google Scholar 

  77. de Wit M, Gennings C, Jenvey WI, Epstein SK (2008) Randomized trial comparing daily interruption of sedation and nursing-implemented sedation algorithm in medical intensive care unit patients. Crit Care 12(3):R70. doi:10.1186/cc6908

    Article  PubMed  PubMed Central  Google Scholar 

  78. Quenot JP, Ladoire S, Devoucoux F, Doise JM, Cailliod R, Cunin N, Aube H, Blettery B, Charles PE (2007) Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Crit Care Med 35(9):2031–2036

    Article  PubMed  Google Scholar 

  79. Arias-Rivera S, Sanchez-Sanchez Mdel M, Santos-Diaz R, Gallardo-Murillo J, Sanchez-Izquierdo R, Frutos-Vivar F, Ferguson ND, Esteban A (2008) Effect of a nursing-implemented sedation protocol on weaning outcome. Crit Care Med 36(7):2054–2060. doi:10.1097/CCM.0b013e31817bfd60

    Article  PubMed  Google Scholar 

  80. Wilhelm W, Kreuer S (2008) The place for short-acting opioids: special emphasis on remifentanil. Crit Care 12(Suppl 3):S5. doi:10.1186/cc6152

    Article  PubMed  PubMed Central  Google Scholar 

  81. Chlan LL, Weinert CR, Skaar DJ, Tracy MF (2010) Patient-controlled sedation: a novel approach to sedation management for mechanically ventilated patients. Chest 138(5):1045–1053. doi:10.1378/chest.09-2615

    Article  PubMed  Google Scholar 

  82. Le Guen M, Liu N, Bourgeois E, Chazot T, Sessler DI, Rouby JJ, Fischler M (2013) Automated sedation outperforms manual administration of propofol and remifentanil in critically ill patients with deep sedation: a randomized phase II trial. Intensive Care Med 39(3):454–462. doi:10.1007/s00134-012-2762-2

    Article  PubMed  Google Scholar 

  83. Mesnil M, Capdevila X, Bringuier S, Trine PO, Falquet Y, Charbit J, Roustan JP, Chanques G, Jaber S (2011) Long-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam. Intensive Care Med 37(6):933–941. doi:10.1007/s00134-011-2187-3

    Article  CAS  PubMed  Google Scholar 

  84. Migliari M, Bellani G, Rona R, Isgro S, Vergnano B, Mauri T, Patroniti N, Pesenti A, Foti G (2009) Short-term evaluation of sedation with sevoflurane administered by the anesthetic conserving device in critically ill patients. Intensive Care Med 35(7):1240–1246. doi:10.1007/s00134-009-1414-7

    Article  CAS  PubMed  Google Scholar 

  85. Wanzuita R, Poli-de-Figueiredo LF, Pfuetzenreiter F, Cavalcanti AB, Westphal GA (2012) Replacement of fentanyl infusion by enteral methadone decreases the weaning time from mechanical ventilation: a randomized controlled trial. Crit Care 16(2):R49. doi:10.1186/cc11250

    Article  PubMed  PubMed Central  Google Scholar 

  86. Balas MC, Burke WJ, Gannon D, Cohen MZ, Colburn L, Bevil C, Franz D, Olsen KM, Ely EW, Vasilevskis EE (2013) Implementing the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle into everyday care: opportunities, challenges, and lessons learned for implementing the ICU Pain, Agitation, and Delirium Guidelines. Crit Care Med 41(9 Suppl 1):S116–S127. doi:10.1097/CCM.0b013e3182a17064

    Article  PubMed  PubMed Central  Google Scholar 

  87. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite RD, Haponik E (2008) Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 36(8):2238–2243. doi:10.1097/CCM.0b013e318180b90e

    Article  PubMed  Google Scholar 

  88. Llano-Diez M, Renaud G, Andersson M, Marrero HG, Cacciani N, Engquist H, Corpeno R, Artemenko K, Bergquist J, Larsson L (2012) Mechanisms underlying ICU muscle wasting and effects of passive mechanical loading. Crit Care 16(5):R209. doi:10.1186/cc11841

    Article  PubMed  PubMed Central  Google Scholar 

  89. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373(9678):1874–1882. doi:10.1016/S0140-6736(09)60658-9

    Article  PubMed  Google Scholar 

  90. Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H, Denehy L, Harrold M, Higgins A, Presneill J, Saxena M, Skinner E, Young P, Webb S (2015) Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care 19:81. doi:10.1186/s13054-015-0765-4

    Article  PubMed  Google Scholar 

  91. Vasilevskis EE, Ely EW, Speroff T, Pun BT, Boehm L, Dittus RS (2010) Reducing iatrogenic risks: ICU-acquired delirium and weakness–crossing the quality chasm. Chest 138(5):1224–1233. doi:10.1378/chest.10-0466

    Article  PubMed  PubMed Central  Google Scholar 

  92. Pandharipande P, Banerjee A, McGrane S, Ely EW (2010) Liberation and animation for ventilated ICU patients: the ABCDE bundle for the back-end of critical care. Crit Care 14(3):157. doi:10.1186/cc8999

    Article  PubMed  PubMed Central  Google Scholar 

  93. Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, Peitz G, Gannon DE, Sisson J, Sullivan J, Stothert JC, Lazure J, Nuss SL, Jawa RS, Freihaut F, Ely EW, Burke WJ (2014) Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med 42(5):1024–1036. doi:10.1097/CCM.0000000000000129

    Article  PubMed  PubMed Central  Google Scholar 

  94. Rahimi RA, Skrzat J, Reddy DR, Zanni JM, Fan E, Stephens RS, Needham DM (2013) Physical rehabilitation of patients in the intensive care unit requiring extracorporeal membrane oxygenation: a small case series. Phys Ther 93(2):248–255. doi:10.2522/ptj.20120336

    Article  PubMed  Google Scholar 

  95. Del Sorbo L, Pisani L, Filippini C, Fanelli V, Fasano L, Terragni P, Dell'Amore A, Urbino R, Mascia L, Evangelista A, Antro C, D'Amato R, Sucre MJ, Simonetti U, Persico P, Nava S, Ranieri VM (2015) Extracorporeal Co2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control. Crit Care Med 43(1):120–127. doi:10.1097/CCM.0000000000000607

    Article  PubMed  Google Scholar 

  96. Fuehner T, Kuehn C, Hadem J, Wiesner O, Gottlieb J, Tudorache I, Olsson KM, Greer M, Sommer W, Welte T, Haverich A, Hoeper MM, Warnecke G (2012) Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 185(7):763–768. doi:10.1164/rccm.201109-1599OC

    Article  PubMed  Google Scholar 

  97. Kredel M, Bischof L, Wurmb TE, Roewer N, Muellenbach RM (2014) Combination of positioning therapy and venovenous extracorporeal membrane oxygenation in ARDS patients. Perfusion 29(2):171–177. doi:10.1177/0267659113502834

    Article  CAS  PubMed  Google Scholar 

  98. Cheng IW, Eisner MD, Thompson BT, Ware LB, Matthay MA (2005) Acute effects of tidal volume strategy on hemodynamics, fluid balance, and sedation in acute lung injury. Crit Care Med 33(1):63–70 discussion 239-240

    Article  PubMed  Google Scholar 

  99. Chlan LL, Weinert CR, Heiderscheit A, Tracy MF, Skaar DJ, Guttormson JL, Savik K (2013) Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial. JAMA 309(22):2335–2344. doi:10.1001/jama.2013.5670

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. Mistraletti G, Umbrello M, Sabbatini G, Miori S, Taverna M, Cerri B, Mantovani ES, Formenti P, Spanu P, D'Agostino A, Salini S, Morabito A, Fraschini F, Reiter RJ, Iapichino G (2015) Melatonin reduces the need for sedation in ICU patients: a randomized controlled trial. Minerva Anestesiol 81(12):1298–1310

    CAS  PubMed  Google Scholar 

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  1. Università degli Studi di Milano, Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, A.S.S.T. dei Santi Paolo e Carlo, Ospedale San Paolo – Polo Universitario, Via A. Di Rudinì, 8, 20142, Milan, Italy

    Giovanni Mistraletti MD, Paolo Formenti MD & Giovanni Sabbatini MD

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  2. Paolo Formenti MD
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  1. Department of "Scienze della Salute", University of Milan, Director of Anaesthesia and Intensive Care Services , ASST Santi Paolo e Carlo, Milan, Italy

    Davide Chiumello

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Mistraletti, G., Formenti, P., Sabbatini, G. (2017). Sedation. In: Chiumello, D. (eds) Acute Respiratory Distress Syndrome. Springer, Cham. https://doi.org/10.1007/978-3-319-41852-0_18

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