Sedation, analgesia, and neuromuscular blockade for high-frequency oscillatory ventilation.

Abstract:

OBJECTIVE:To provide a comprehensive review of the issue related to the administration of sedative, analgesic, and neuromuscular blocking agents (NMBA) to patients who are receiving ventilatory support for acute respiratory distress syndrome (ARDS) with high-frequency oscillatory ventilation. RESULTS:Sedative, analgesic, and NMBA are used with great frequency in patients with severe ARDS who are undergoing high-frequency oscillatory ventilation. In particular, the use of NMBA has been higher than for other ARDS populations. Important considerations for effective treatment include careful patient evaluation, patient-based medication selection, identification of treatment goals with periodic re-assessment, titration of medications to objective parameters such as sedation scales and peripheral nerve stimulation, use of intermittent therapy when feasible, implementation of drug interruption strategies, and discontinuation of medications at the earliest possible time. It is important to recognize that patients evolve from severe ARDS through phases of recovery to the resolution of respiratory failure and that ventilatory management, as well as sedative and related medication requirements, will vary markedly over the course of this process. CONCLUSIONS:A multidisciplinary, structured approach that is based on the considerations described should help achieve optimal results in this challenging patient population.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Sessler CN

doi

10.1097/01.ccm.0000156794.96880.df

subject

Has Abstract

pub_date

2005-03-01 00:00:00

pages

S209-16

issue

3 Suppl

eissn

0090-3493

issn

1530-0293

pii

00003246-200503001-00016

journal_volume

33

pub_type

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