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2008, Número 2

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Med Sur 2008; 15 (2)


Uso de sedantes y analgésicos en la Unidad de Terapia Intensiva del Hospital de la Fundación Clínica Médica Sur

Remolina SM

Idioma: Español
Referencias bibliográficas: 38
Paginas: 58-67
Archivo PDF: 124.07 Kb.


RESUMEN

Es un estudio clínico original prospectivo, retrolectivo y comparativo. Se presentan en forma cuantitativa los fármacos empleados para sedación y analgesia intravenosa continua, combinada o secuencial de todos los pacientes atendidos en un periodo de cinco años en la UTI de Médica Sur. Se incluyeron 1,507 pacientes admitidos en la UTI de Médica Sur. Aproximadamente la mitad corresponde a cada género, la mitad a casos quirúrgicos (CQ) y médicos (CM) y la edad promedio de 53 años (10 a 97). Del total de los pacientes, recibieron uno o más de los medicamentos de estudio 1,165 (77%); 62% correspondió a CQ y 37% a CM. Por grupo son 480 pacientes de CQ con ventilación mecánica (VM) y 362 (72%) recibieron uno o más medicamentos sedantes/analgésicos (S/A), los CQ sin VM 357; 337 recibieron (S/A) (94%). El grupo de CM con VM hubo 290 casos en total con 278 (95%) que recibieron (S/A), el resto son 380 CM sin VM y que sólo 188 que representan 49% recibieron alguno de los medicamentos del estudio. Los resultados más interesantes muestran al comparar los años, un aumento en la proporción de pacientes que recibieron fentanilo, propofol y dexmedetomidina. Hubo reducción en la proporción de pacientes que recibieron midazolam. En contraste se nota un aumento en las cantidades promedio y totales empleadas de dexmedetomidina y midazolam, así como cantidades menores en promedio y total diarias de fentanilo y propofol.
En conclusión se usan dosis menores de algunos fármacos en relación con mayores dosis de dexmedetomidina en combinación. Una proporción menor de pacientes recibió midazolam en comparación con los primeros años, y las dosis promedio y las cantidades totales fueron mayores.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Puntillo KA. Pain experiences of intensive care unit patients. Heart Lung 1990; 19: 526-533.

  2. Jacobi J, Fraser GL, Coursin DB et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30: 119-141.

  3. Ely EW, Inouye SK, Bernard GR et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit [CAM-ICU]. JAMA 2001; 286: 2703-2710.

  4. Griffiths RD, Jones C, MacMillan RR. Where is the harm in not knowing? Care after intensive care. Clin Intensive Care 1996; 7: 144-145.

  5. Jones C, Griffiths RD, Humphris G et al. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 2001; 29: 573-580.

  6. Gehlbach BK, Kress JP. Sedation in the intensive care unit. Current Opinion in Critical Care 2002; 8: 290-298.

  7. Stoltzfus DP. Advantages and disadvantages of combining sedative agents. Crit Care Clin 1995; 11: 903-912.

  8. Bodenham A, Shelly MP, Park GR. The altered pharmacokinetics and pharmacodynamics of drugs commonly used in critically ill patients. Clin Pharmacokinet 1988; 14: 347-373.

  9. Wagner BKJ, O’Hara DA. Pharmacokinetics and pharmacodynamics of sedatives and analgesics in the treatment of agitated critically ill patients. Clin Pharmacokinet 1997; 33: 426-453.

  10. Bertz RJ, Granneman GR. Use of in vitro and in vivo data to estimate the likelihood of metabolic pharmacokinetic interactions. Clin Pharmacokinet 1997; 32: 210-258.

  11. Pohlman AS, Simpson K, Hall J. Continuous intravenous infusions of lorazepam versus midazolam for sedation during mechanical ventilatory support: a prospective, randomized study. Crit Care Med 1994; 22: 1241-1247.

  12. Oldenhof H, de Jong M, Steenhoek A et al. Clinical pharmacokinetics of midazolam in intensive care patients, a wide interpatient variability? Clin Pharmacol Ther 1988; 43: 263-269.

  13. Dundee JW, Samuel IO, Toner W et al. Midazolam: A water-soluble benzodiazepine. Studies in volunteers. Anaesthesia 1980; 35: 454-458.

  14. Michalk S, Moncorge C, Fichelle A et al. Midazolam infusion for basal sedation in intensive care: Absence of accumulation. Intensive Care Med 1988; 15: 37-41.

  15. Shelly MP, Mendel L, Park GR. Failure of critically ill patients to metabolize midazolam. Anaesthesia 1987; 42: 619-626.

  16. Vree TB, Shimoda M, Driessen JJ, et al. Decreased plasma albumin concentration results in increased volume of distribution and decreased elimination of midazolam in intensive care patients. Clin Pharmacol Ther 1989; 46: 537-544.

  17. Driessen JJ, Vree TB, Guelen PJ. The effects of acute changes in renal function on the pharmacokinetics of midazolam during long-term infusion in ICU patients. Acta Anaesthesiol Belg 1991; 42: 149-155.

  18. Byatt CM, Lewis LD, Dawling S et al. Accumulation of midazolam after repeated dosage in patients receiving mechanical ventilation in an intensive care unit. BMJ 1984; 289: 799-800.

  19. Malacrida R, Fritz ME, Suter PM et al. Pharmacokinetics of midazolam administered by continuous intravenous infusion to intensive care patients. Crit Care Med 1992; 20: 1123-1126.

  20. Kollef MH, Levy NT, Ahrens TS et al. The use of continuous IV sedation is associated with prolongation of mechanical ventilation. Chest 1998; 114: 541-548.

  21. Kress JP, Pohlman A, O’Connor MF, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342: 1471-1477.

  22. Brook AD, Ahrens TS, Schaiff R et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 1999; 27: 2609-2615.

  23. Cammarano WB, Pittet JF, Weitz S, et al. Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients. Crit Care Med 1998; 26: 676-684.

  24. Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002; 95: 461-466.

  25. Venn RM, Bradshaw CJ, Spencer R et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 1999; 54: 1136-1142.

  26. Venn RM, Karol MD, Grounds RM. Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive caret. Br J Anaesth 2002; 88: 669-675.

  27. Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: Patient and clinician perceptions. Br J Anaesth 2001; 87: 684-690.

  28. Hogarth DK, Hall J. Management of sedation in mechanically ventilated patients. Curr Opin Crit Care 10: 40-46.

  29. Liu LL, Gropper MA. Postoperative analgesia and sedation in the adult intensive care unit: A guide to drug selection. Drugs 2003; 63: 755-767.

  30. Jacobi J, Fraser GL, Coursin DB et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30: 119-141.

  31. Egerod I. Uncertain terms of sedation in ICU: How nurses and physicians manage and describe sedation for mechanically ventilated patients. J Clin Nurs 2002; 11: 831-840.

  32. Celis-Rodriguez E, Besso J, Birchenall C, De la Cal MA, Carrillo R, Castorena G, Ceraso D, Dueñas C, Gil F, Jimenez E, Meza JC, Muñoz M, Pacheco C, Palizas F, Pinilla D, Raffán F, Raimondi N, Rubiano S, Suárez M, Ugarte S. Guía de práctica clínica basada en la evidencia para el manejo de la sedo-analgesia en el paciente adulto críticamente enfermo. Med Intensiva 2007; 31(8): 428-71.

  33. Ramsey MAE, Savege TM, Simpson BRJ et al. Controlled sedation with alphalaxone-alphadolone. BMJ 1974; 2: 256-259.

  34. Riker RR, Picard JT, Fraser GL. Prospective evaluation of the sedation-agitation scale for adult critically ill patients. Crit Care Med 1999; 27: 1325-1329.

  35. Crippen DW. Neurologic monitoring in the intensive care unit. New Horiz 1994; 2: 107-120.

  36. Hansen-Flaschen J, Cowen J, Polomano RC. Beyond the Ramsay scale: Need for a validated measure of sedating drug efficacy in the intensive care unit. Crit Care Med 1994; 22: 732-733.

  37. Sessler CN, Gosnell M, Grap MJ et al. A new agitation-sedation scale for critically ill patients: development and testing of validity and inter rater reliability [abstract]. Am J Respir Crit Care Med 2000; 161: A506.

  38. Simmons LE, Riker RR, Prato BS et al. Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the sedation-agitation scale. Crit Care Med 1999; 27: 1499-1504.




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