Impact of an Analgesia-Based Sedation Protocol on Mechanically Ventilated Patients in a Medical Intensive Care Unit.


BACKGROUND:Recent attention to adverse effects of intensive care unit (ICU) sedation has led to the use of strategies that target a "lighter" depth of sedation. Among these strategies are "analgosedation" protocols, which prioritize pain management and preferentially use IV opioids before administration of continuously infused sedatives such as propofol or midazolam. We hypothesized that using an analgosedation protocol would result in a shorter duration of mechanical ventilation than a protocol with greater emphasis on IV sedatives METHODS:: We conducted a retrospective study comparing the duration of mechanical ventilation before and after implementation of an analgosedation protocol in a 24-bed medical ICU. Patients were aged 18 years or older and required mechanical ventilation where a light level of sedation was clinically appropriate. Exclusion criteria included a clinical need for deeper levels of sedation or tracheal intubation confined to the perioperative period. RESULTS:Seventy-nine patients were included in the postimplementation group and 65 in the preimplementation group. After adjustment for baseline covariates, introduction of the 2013 analgosedation protocol was associated with a decreased duration of mechanical ventilation (-26.62 hours; 95% confidence interval, - 44.98 to -8.26, P = 0.005). Patients managed with the analgosedation protocol experienced a lighter level of sedation (median Richmond Agitation-Sedation Scale, -2.57 vs -1.25, P = 0.001) and improved pain management (median Critical-Care Pain Observation Tool score, 2.0 vs 1.5, P = 0.03). The use of continuously infused sedatives was reduced by 54.3% (92.3% vs 38.0%, P < 0.001). CONCLUSIONS:Our findings suggest that implementation of an analgosedation protocol was associated with an overall lighter level of sedation, shorter mean ventilator duration, and a reduced use of continuous infusion sedatives. Further studies are needed to assess the impact of such protocols on ICU delirium.


Anesth Analg


Anesthesia and analgesia


Faust AC,Rajan P,Sheperd LA,Alvarez CA,McCorstin P,Doebele RL




Has Abstract


2016-10-01 00:00:00














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    abstract:BACKGROUND:Inhibitors of cyclooxygenase, which block the formation of prostaglandin (PG) E2, are the standard treatment of inflammatory pain. These drugs, however, have serious gastrointestinal, renal, and cardiovascular side effects that limit their clinical use. Cyclodextrins are neutral glucose oligomers that form a...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Sauer RS,Rittner HL,Roewer N,Sohajda T,Shityakov S,Brack A,Broscheit JA

    更新日期:2017-02-01 00:00:00

  • The coherent frequency in the electroencephalogram as an objective measure of cognitive function during propofol sedation.

    abstract::Ten volunteers were studied during six stages of propofol sedation, namely awake (no propofol), light sedation (small dose of propofol), deep sedation (large dose), deep sedation with stimulation of the ulnar nerve, then light sedation again (small dose), and awake (recovery). Light and deep sedation were defined in t...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


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  • Spine Surgery and Blood Loss: Systematic Review of Clinical Evidence.

    abstract::Spine surgery has been growing rapidly as a neurosurgical operation, with an increase of 220% over a 15-year period. Intraoperative blood transfusion is a major outcome determinant of spine procedures. Various approaches, including pharmacologic and nonpharmacologic therapies, have been tested to decrease both intraop...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,评审


    authors: Willner D,Spennati V,Stohl S,Tosti G,Aloisio S,Bilotta F

    更新日期:2016-11-01 00:00:00

  • Subblocking concentrations of local anesthetics: effects on impulse generation and conduction in single myelinated sciatic nerve axons in frog.

    abstract::Phenomena seen in axons exposed to subblocking doses serve as the basis for interpreting clinical and behavioral observations during onset and recovery of peripheral nerve block. To delineate the changes in excitability and in impulse conduction caused by subblocking concentrations of local anesthetics (LAs) in myelin...

    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


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  • Sacroiliac joint radiofrequency ablation with a multilesion probe: a case series of 60 patients.

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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章,多中心研究


    authors: Schmidt PC,Pino CA,Vorenkamp KE

    更新日期:2014-08-01 00:00:00

  • A weak negative inotropic effect of protamine sulfate upon the isolated canine heart muscle.

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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


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  • Changing Default Ventilator Settings on Anesthesia Machines Improves Adherence to Lung-Protective Ventilation Measures.

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    authors: Chiao SS,Colquhoun DA,Naik BI,Ma JZ,Nemergut EC,Durieux ME,Blank RS,Forkin KT

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  • Myocardial dysfunction associated with proinflammatory cytokines after esophageal resection.

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  • Sigma receptor activation does not mediate fentanyl-induced attenuation of muscarinic coronary contraction.

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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


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  • Effect of cardiopulmonary bypass on plasma levels of nifedipine.

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    journal_title:Anesthesia and analgesia

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    journal_title:Anesthesia and analgesia

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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Lin CY

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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


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    pub_type: 杂志文章


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    pub_type: 杂志文章


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  • Electroencephalographic burst suppression in elderly and young patients anesthetized with isoflurane.

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    journal_title:Anesthesia and analgesia

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    authors: Schwartz AE,Tuttle RH,Poppers PJ

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  • Gamma-aminobutyric acid type A receptor β3 subunit forebrain-specific knockout mice are resistant to the amnestic effect of isoflurane.

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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Rau V,Oh I,Liao M,Bodarky C,Fanselow MS,Homanics GE,Sonner JM,Eger EI 2nd

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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Scott JA,Wood M,Flood P

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  • The intrathoracic blood volume index as an indicator of fluid responsiveness in critically ill patients with acute circulatory failure: a comparison with central venous pressure.

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    pub_type: 杂志文章


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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Kahn RL,Hargett MJ

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    pub_type: 杂志文章


    authors: Jimenez N,Posner KL,Cheney FW,Caplan RA,Lee LA,Domino KB

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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


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    pub_type: 杂志文章,meta分析,评审


    authors: Gattas DJ,Dan A,Myburgh J,Billot L,Lo S,Finfer S,CHEST Management Committee.

    更新日期:2012-01-01 00:00:00

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    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章


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    更新日期:1989-03-01 00:00:00

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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Lu Y,Sweitzer SM,Laurito CE,Yeomans DC

    更新日期:2004-02-01 00:00:00

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    journal_title:Anesthesia and analgesia

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Cappelleri G,Aldegheri G,Danelli G,Marchetti C,Nuzzi M,Iannandrea G,Casati A

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    journal_title:Anesthesia and analgesia

    pub_type: 杂志文章


    authors: Sakata DJ,Gopalakrishnan NA,Orr JA,White JL,Westenskow DR

    更新日期:2007-07-01 00:00:00