Sedation for Patients with Sepsis: Towards a Personalised Approach
Abstract
:1. Introduction
2. Monitoring Sedoanalgesia
2.1. Evaluating and Monitoring Pain
2.2. Evaluating and Monitoring Sedation
2.3. Diagnosis of Delirium
3. Sedation via Intravenous Agents
3.1. Propofol
3.2. Dexmedetomidine
3.3. Antipsychotics
3.4. Analgesic Agents
3.5. Drug Selection: Conmbinations and Rotation of Intravenous Sedative Drugs
4. The Role of Inhaled Sedation Agents
4.1. Special Circumstances for Consideration with Sepsis Patients
4.1.1. Sepsis Patients with ARDS
4.1.2. Sepsis Patients with Myocardial Dysfunction
4.1.3. Sepsis-Associated Encephalopathy
4.1.4. Continuous Renal Replacement Therapy and Extracorporeal Membrane Oxygenation
5. Conclusions and Future Directions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Kotani, Y.; Pruna, A.; Turi, A.; Borghi, G.; Lee, T.C.; Zangrillo, A.; Landoni, G.; Pasin, L. Propofol and survival: An updated meta-analysis of randomized clinical trials. Crit. Care 2023, 27, 139–148. [Google Scholar] [CrossRef]
- Kotani, Y.; Piersanti, G.; Miucci, G.; Fresilli, S.; Turi, S.; Montanaro, G.; Zangrillo, A.; Lee, T.C.; Landoni, G. Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials. J. Crit. Care 2023, 77, 154317. [Google Scholar] [CrossRef]
- Mulier, J.P.; Wouters, R.; Dillemans, B.; De Kock, M. A randomized controlled double- blind trial evaluating the effect of opioid-free versus opioid general anesthesia on postoperative pain and discomfort measured by the QoR-40. J. Clin. Anesth. Pain Med. 2018, 2, 15. [Google Scholar]
- Degenhardt, L.; Grebely, J.; Stone, J.; Hickman, M.; Vickerman, P.; Marshall, B.D.L.; Bruneau, J.; Altice, F.L.; Henderson, G.; Rahimi-Movaghar, A.; et al. Global patterns of opioid use and dependence: Harms to populations, interventions and future action. Lancet 2019, 394, 1560–1579. [Google Scholar] [CrossRef]
- Proposal for a Regulation of the European Parliament and of The Council on Fluorinated Greenhouse Gases, Amending Directive (EU) 2019/1937 and Repealing Regulation (EU) No 517/2014. Available online: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A52022PC0150 (accessed on 5 June 2023).
- Jarzack, D.; Kluge, S.; Nierhaus, A. Sepsis—Pathophysiology and therapeutic concepts. Front. Med. 2021, 8, 628203. [Google Scholar]
- Singer, M.; Deutschman, C.S.; Seymour, C.W.; Shankar-Hari, M.; Annane, D.; Bauer, M.; Bellomo, R.; Bernard, G.R.; Chiche, J.D.; Coopersmith, C.M.; et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016, 315, 801–810. [Google Scholar] [CrossRef]
- Angus, D.C.; van der Poll, T. Severe sepsis and septic shock. N. Engl. J. Med. 2013, 369, 840–851. [Google Scholar] [CrossRef] [PubMed]
- Spapen, H.D.; Jacobs, R.; Honoré, P.M. Sepsis-induced multi-organ dysfunction syndrome—A mechanistic approach. J. Emerg. Crit. Care Med. 2017, 1, 27. [Google Scholar] [CrossRef]
- Abraham, E.; Singer, M. Mechanisms of sepsis-induced organ dysfunction. Crit. Care Med. 2007, 35, 2408–2416. [Google Scholar] [CrossRef]
- Charlton, M.; Thompson, J.P. Pharmacokinetics in sepsis. BJA Educ. 2019, 19, 7–13. [Google Scholar] [CrossRef] [PubMed]
- Sessler, C.N.; Grap, M.J.; Ramsay, M. Evaluating and monitoring analgesia and sedation in the intensive care unit. Crit. Care 2008, 12 (Suppl. S3), S2. [Google Scholar] [CrossRef]
- Sessler, C.N.; Grap, M.J.; Brophy, G.M. Multidisciplinary management of sedation and analgesia in critical care. Semin. Respir. Crit. Care Med. 2001, 22, 211–225. [Google Scholar] [CrossRef]
- Seo, Y.; Lee, H.J.; Ha, E.J.; Ha, T.S. 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit. Acute Crit Care 2022, 37, 1–25. [Google Scholar] [CrossRef]
- Pun, B.T.; Balas, M.C.; Barnes-Daly, M.A.; Thompson, J.L.; Aldrich, J.M.; Barr, J.; Byrum, D.; Carson, S.S.; Devlin, J.W.; Engel, H.J.; et al. Caring for critically ill patients with the ABCDEF bundle: Results of the ICU liberation collaborative in over 15,000 adults. Crit. Care Med. 2019, 47, 3–14. [Google Scholar] [CrossRef] [PubMed]
- Vincent, J.L.; Shehabi, Y.; Walsh, T.S.; Pandharipande, P.P.; Ball, J.A.; Spronk, P.; Longrois, D.; Strøm, T.; Conti, G.; Funk, G.C.; et al. Comfort and patient-centred care without excessive sedation: The eCASH concept. Intensive Care Med. 2016, 42, 962–971. [Google Scholar] [CrossRef]
- Celis-Rodríguez, E.; Díaz Cortés, J.C.; Cárdenas Bolívar, Y.R.; Carrizosa González, J.A.; Pinilla, D.I.; Ferrer Záccaro, L.E.; Birchenall, C.; Caballero López, J.; Argüello, B.M.; Castillo Abrego, G.; et al. Evidence-based clinical practice guidelines for the management of sedoanalgesia and delirium in critically ill adult patients. Med. Intensiva. 2020, 44, 171–184. [Google Scholar] [CrossRef]
- Gelinas, C.; Fillion, N.; Puntiko, K.A.; Viens, C.; Fortier, M. Validation of the critical care pain observation tool in adult patients. Am. J. Crit. Care 2006, 15, 420–427. [Google Scholar] [CrossRef]
- Latorre Marco, I.; Solís Muñoz, M.; Falero Ruiz, T.; Larrasquitu Sánchez, A.; Romay Pérez, A.B.; Millán Santos, I. Validation of the Scale of Behavior Indicators of Pain (ESCID) in critically ill, non-communicative patients under mechanical ventilation: Results of the ESCID scale. Enferm. Intensiva. 2011, 22, 3–12. [Google Scholar] [CrossRef]
- Abad-Gurumeta, A.; Ripollés-Melchor, J.; Casans-Francés, R.; Calvo-Vecino, J.M. Monitoring of nociception, reality or fiction? Rev. Esp. Anestesiol. Reanim. 2017, 64, 406–414. [Google Scholar] [CrossRef]
- Becker, D.E.; Rosenberg, M. Nitrous oxide and the inhalation anesthetics. Anesth. Prog. 2008, 55, 124–130. [Google Scholar] [CrossRef]
- Stollings, J.L.; Kotfis, K.; Chanques, G.; Pun, B.T.; Pandharipande, P.P.; Ely, E.W. Delirium in critical illness: Clinical manifestations, outcomes and management. Intensive Care Med. 2021, 47, 1089–1103. [Google Scholar] [CrossRef]
- Green, C.; Bonavia, W.; Toh, C.; Tiruvoipati, R. Prediction of ICU delirium: Validation of current delirium predictive models in routine clinical practice. Crit. Care Med. 2019, 47, 428–435. [Google Scholar] [CrossRef]
- Herman, S.T.; Abend, N.S.; Bleck, T.P.; Chapman, K.E.; Drislane, F.W.; Emerson, R.G.; Gerard, E.E.; Hahn, C.D.; Husain, A.M.; Kaplan, P.W.; et al. Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society. Consensus statement on continuous EEG in critically ill adults and children, part I: Indications. J. Clin. Neurophysiol. 2015, 32, 87–95. [Google Scholar] [CrossRef] [PubMed]
- Gilmore, E.J.; Gaspard, N.; Choi, H.A.; Cohen, E.; Burkart, K.M.; Chong, D.H.; Claassen, J.; Hirsch, L.J. Acute brain failure in severe sepsis: A prospective study in the medical intensive care unit utilizing continuous EEG monitoring. Intensive Care Med. 2015, 41, 686–694. [Google Scholar] [CrossRef] [PubMed]
- Heavner, M.S.; Gorman, E.F.; Linn, D.D.; Yeung, S.Y.A.; Miano, T.A. Systematic review and meta-analysis of the correlation between bispectral index (BIS) and clinical sedation scales: Toward defining the role of BIS in critically ill patients. Pharmacotherapy 2022, 42, 667–676. [Google Scholar] [CrossRef] [PubMed]
- Schuller, P.J.; Newell, S.; Strickland, P.A.; Barry, J.J. Response of bispectral index to neuromuscular block in awake volunteers. Br. J. Anaesth. 2015, 115, i95–i103. [Google Scholar] [CrossRef]
- Shetty, R.M.; Bellini, A.; Wijayatilake, D.S.; Hamilton, M.A.; Jain, R.; Karanth, S.; Namachivayam, A. BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization. Cochrane Database Syst. Rev. 2018, 2, CD011240. [Google Scholar] [CrossRef]
- Dickerson, R.N.; Buckley, C.T. Impact of propofol sedation upon caloric overfeeding and protein inadequacy in critically ill patients receiving nutrition support. Pharmacy 2021, 9, 121. [Google Scholar] [CrossRef] [PubMed]
- Chowdhury, T.; Thapa, A.; Kadakia, N.; Khadka, N.; Gousy, N. Propofol Infusion Syndrome: A Rare Complication From a Common Medication. Cureus 2022, 14, e31940. [Google Scholar] [CrossRef]
- Lonardo, N.W.; Mone, M.C.; Nirula, R.; Kimball, E.J.; Ludwig, K.; Zhou, X.; Sauer, B.C.; Nechodom, K.; Teng, C.; Barton, R.G. Propofol is associated with favorable outcomes compared with benzodiazepines in ventilated intensive care unit patients. Am. J. Resp. Crit. Care Med. 2014, 189, 1383–1394. [Google Scholar] [CrossRef]
- Gottlieb, M.; Koyfman, A.; Long, B. Evaluation and Management of Abdominal Compartment Syndrome in the Emergency Department. J. Emerg Med. 2020, 58, 43–53. [Google Scholar] [CrossRef]
- Chanques, G.; Constantin, J.M.; Devlin, J.W.; Ely, E.W.; Fraser, G.L.; Gélinas, C.; Girard, T.D.; Guérin, C.; Jabaudon, M.; Jaber, S.; et al. Analgesia and sedation in patients with ARDS. Intensive Care Med. 2020, 46, 2342–2356. [Google Scholar] [CrossRef] [PubMed]
- Oxlund, J.; Knudsen, T.; Sorberg, M.; Strom, T.; Toft, P.; Jennum, P.J. Sleep quality and quantity determined by polysomnography in mechanically ventilated critically ill patients randomized to dexmedetomidine or placebo. Acta Anaesthesiol. Scand. 2023, 67, 66–75. [Google Scholar] [CrossRef]
- Palakshappa, J.A.; Hough, C.L. How We Prevent and Treat Delirium in the ICU. Chest 2021, 160, 1326–1334. [Google Scholar] [CrossRef] [PubMed]
- Mart, M.F.; Roberson, S.W.; Salas, B.; Pandharipande, P.P.; Ely, E.W. Prevention and Management of Delirium in the Intensive Care Unit. Semin. Respir. Crit. Care Med. 2021, 42, 112–126. [Google Scholar] [CrossRef] [PubMed]
- Casamento, A.J.; Serpa Neto, A.; Young, M.; Lawrence, M.; Taplin, C.; Eastwood, G.M.; Ghosh, A.; Bellomo, R. A Phase II Cluster-Crossover Randomized Trial of Fentanyl versus Morphine for Analgosedation in Mechanically Ventilated Patients. Am. J. Respir. Crit. Care Med. 2021, 204, 1286–1294. [Google Scholar] [CrossRef] [PubMed]
- Yang, S.; Zhao, H.; Wang, H.; Zhang, H.; An, Y. Comparison between remifentanil and other opioids in adult critically ill patients: A systematic review and meta-analysis. Medicine 2021, 100, e27275. [Google Scholar] [CrossRef]
- Shehabi, Y.; Serpa Neto, A.; Howe, B.D.; Bellomo, R.; Arabi, Y.M.; Bailey, M.; Bass, F.E.; Kadiman, S.B.; McArthur, C.J.; Reade, M.C.; et al. Early sedation with dexmedetomidine in ventilated critically ill patients and heterogeneity of treatment effect in the SPICE III randomised controlled trial. Intensive Care Med. 2021, 47, 455–466. [Google Scholar] [CrossRef]
- Jakob, S.M.; Ruokonen, E.; Grounds, R.M.; Sarapohja, T.; Garratt, C.; Pocock, S.J.; Bratty, J.R.; Takala, J.; Dexmedetomidine for Long-Term Sedation Investigators. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: Two randomized controlled trials. JAMA 2012, 307, 1151–1160. [Google Scholar] [CrossRef]
- Shehabi, Y.; Serpa Neto, A.; Bellomo, R.; Howe, B.D.; Arabi, Y.M.; Bailey, M.; Bass, F.E.; Bin Kadiman, S.; McArthur, C.J.; Reade, M.C.; et al. Dexmedetomidine and Propofol Sedation in Critically Ill Patients and Dose-associated 90-Day Mortality: A Secondary Cohort Analysis of a Randomized Controlled Trial (SPICE III). Am. J. Respir. Crit. Care Med. 2023, 207, 876–886. [Google Scholar] [CrossRef]
- Buckley, M.S.; Agarwal, S.K.; MacLaren, R.; Kane-Gill, S.L. Adverse Hemodynamic Events Associated With Concomitant Dexmedetomidine and Propofol for Sedation in Mechanically Ventilated ICU Patients. J. Intensive Care Med. 2020, 35, 1536–1545. [Google Scholar] [CrossRef]
- Heybati, K.; Zhou, F.; Ali, S.; Deng, J.; Mohananey, D.; Villablanca, P.; Ramakrishna, H. Outcomes of dexmedetomidine versus propofol sedation in critically ill adults requiring mechanical ventilation: A systematic review and meta-analysis of randomised controlled trials. Br. J. Anaesth. 2022, 129, 515–526. [Google Scholar] [CrossRef] [PubMed]
- Erstad, B.L.; Barletta, J.F. Drug dosing in the critically ill obese patient-a focus on sedation, analgesia and delirium. Crit. Care 2020, 24, 315. [Google Scholar] [CrossRef] [PubMed]
- Yassen, K.A.; Jabaudon, M.; Alsultan, H.A.; Almousa, H.; Shahwar, D.I.; Alhejji, F.Y.; Aljaziri, Z.Y. Inhaled Sedation with Volatile Anesthetics for Mechanically Ventilated Patients in Intensive Care Units: A Narrative Review. J. Clin. Med. 2023, 12, 1069. [Google Scholar] [CrossRef] [PubMed]
- Bomberg, H.; Wessendorf, M.; Bellgardt, M.; Veddeler, M.; Wagenpfeil, S.; Volk, T.; Groesdonk, H.V.; Meiser, A. Evaluating the efficiency of desflurane refelction in two comercially available reflectors. J. Clin. Monit. Comput. 2018, 32, 605–614. [Google Scholar] [CrossRef]
- Meiser, A.; Volk, T.; Wallenborn, J.; Guenther, U.; Becher, T.; Bracht, H.; Schwarzkopf, K.; Knafelj, R.; Faltlhauser, A.; Thal, S.C.; et al. Inhaled isoflurane via the anaesthetic conserving device versus propofol for sedation of invasively ventilated patients in intensive care units in Germany and Slovenia: An open-label, phase 3, randomised controlled, non-inferiority trial. Lancet Respir. Med. 2021, 9, 1231–1240. [Google Scholar] [CrossRef]
- Bellgardt, M.; Georgevici, A.I.; Klutzny, M.; Drees, D.; Meiser, A.; Gude, P.; Vogelsang, H.; Weber, T.P.; Herzog-Niescery, J. Use of MIRUSTM for MAC-driven application of isoflurane, sevoflurane and desflurane in postoperative ICU patients: A randomized controlled trial. Ann. Intensive Care 2019, 9, 118. [Google Scholar] [CrossRef]
- Röhm, K.D.; Mengistu, A.; Boldt, J.; Mayer, J.; Beck, G.; Piper, S.N. Renal integrity in sevoflurane sedation in the intensive care unit with the anesthetic-conserving device: A comparison with intravenous propofol sedation. Anesth. Analg. 2009, 108, 1848–1854. [Google Scholar] [CrossRef]
- Jerath, A.; Panckhurst, J.; Parotto, M.; Lightfoot, N.; Wasowicz, M.; Ferguson, N.D.; Steel, A.; Beattie, W.S. Safety and Efficacy of Volatile Anesthetic Agents Compared With Standard Intravenous Midazolam/Propofol Sedation in Ventilated Critical Care Patients: A Meta-analysis and Systematic Review of Prospective Trials. Anesth. Analg. 2017, 124, 1190–1199. [Google Scholar] [CrossRef]
- Vincent, J.L.; Rello, J.; Marshall, J.; Silva, E.; Anzueto, A.; Martin, C.D.; Moreno, R.; Lipman, J.; Gomersall, C.; Sakr, Y.; et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009, 302, 2323–2329. [Google Scholar] [CrossRef]
- Ferrando, C.; Aguilar, G.; Piqueras, L.; Soro, M.; Moreno, J.; Belda, F.J. Sevoflurane, but not propofol, reduces the lung inflammatory response and improves oxygenation in an acute respiratory distress syndrome model: A randomised laboratory study. Eur. J. Anaesthesiol. 2013, 30, 455–463. [Google Scholar] [CrossRef] [PubMed]
- Voigtsberger, S.; Lachmann, R.A.; Leutert, A.C.; Schläpfer, M.; Booy, C.; Reyes, L.; Urner, M.; Schild, J.; Schimmer, R.C.; Beck-Schimmer, B. Sevoflurane ameliorates gas exchange and attenuates lung damage in experimental lipopolysaccharide-induced lung injury. Anesthesiology 2009, 111, 1238–1248. [Google Scholar] [CrossRef]
- Stollings, L.M.; Jia, L.J.; Tang, P.; Dou, H.; Lu, B.; Xu, Y. Immune Modulation by Volatile Anesthetics. Anesthesiology 2016, 125, 399–411. [Google Scholar] [CrossRef] [PubMed]
- Jabaudon, M.; Boucher, P.; Imhoff, E.; Chabanne, R.; Faure, J.S.; Roszyk, L.; Thibault, S.; Blondonnet, R.; Clairefond, G.; Guérin, R.; et al. Sevoflurane for Sedation in Acute Respiratory Distress Syndrome. A Randomized Controlled Pilot Study. Am. J. Respir. Crit. Care Med. 2017, 195, 792–800. [Google Scholar] [CrossRef]
- Mehta, S.; Behr, G.; Kenyon, D. The effect of volatile anaesthetics on common respiratory pathogens. Halothane, trichloroethylene and methoxyflurane. Anaesthesia 1974, 29, 280–289. [Google Scholar] [CrossRef] [PubMed]
- Martínez-Serrano, M.; Gerónimo-Pardo, M.; Martínez-Monsalve, A.; Crespo-Sánchez, M.D. Antibacterial effect of sevoflurane and isoflurane. Rev. Esp. Quimioter. 2017, 30, 84–89. [Google Scholar]
- Rooke, G.A.; Choi, J.H.; Bishop, M.J. The effect of isoflurane, halothane, sevoflurane, and thiopental/nitrous oxide on respiratory system resistance after tracheal intubation. Anesthesiology 1997, 86, 1294–1299. [Google Scholar] [CrossRef]
- Carrié, S.; Anderson, T.A. Volatile anesthetics for status asthmaticus in pediatric patients: A comprehensive review and case series. Paediatr. Anaesth. 2015, 25, 460–467. [Google Scholar] [CrossRef] [PubMed]
- Flinspach, A.N.; Zacharowski, K.; Ioanna, D.; Adam, E.H. Volatile isoflurane in critically ill coronavirus disease 2019 patients. A case series and systematic review. Crit. Care Explor. 2020, 2, e0256. [Google Scholar] [CrossRef]
- Marcos-Vidal, J.M.; Merino, M.; González, R.; García, C.; Rey, S.; Pérez, I. Comparison of the use of AnaConDa® versus AnaConDa-S® during the post-operative period of cardiac surgery under standard conditions of practice. J. Clin. Monit. Comput. 2020, 34, 89–95. [Google Scholar] [CrossRef]
- Blondonnet, R.; Simand, L.A.; Vidal, P.; Borao, L.; Bourguignon, N.; Morand, D.; Bernard, L.; Roszyk, L.; Audard, J.; Godet, T.; et al. Design and Rationale of the Sevoflurane for Sedation in Acute Respiratory Distress Syndrome (SESAR) Randomized Controlled Trial. J. Clin. Med. 2022, 11, 2796. [Google Scholar] [CrossRef] [PubMed]
- Geri, G.; Vignon, P.; Aubry, A.; Fedou, A.L.; Charron, C.; Silva, S.; Repessé, X.; Vieillard-Baron, A. Cardiovascular clusters in septic shock combining clinical and echocardiographic parameters: A post hoc analysis. Intensive Care Med. 2019, 45, 657–667. [Google Scholar] [CrossRef] [PubMed]
- Habimana, R.; Choi, I.; Cho, H.J.; Kim, D.; Lee, K.; Jeong, I. Sepsis-induced cardiac dysfunction: A review of pathophysiology. Acute Crit. Care. 2020, 35, 57–66. [Google Scholar] [CrossRef] [PubMed]
- Qiao, S.G.; Sun, Y.; Sun, B.; Wang, A.; Qiu, J.; Hong, L.; An, J.Z.; Wang, C.; Zhang, H.L. Sevoflurane postconditioning protects against myocardial ischemia/reperfusion injury by restoring autophagic flux via an NO-dependent mechanism. Acta Pharmacol. Sin. 2019, 40, 35–45. [Google Scholar] [CrossRef] [PubMed]
- Steurer, M.P.; Steurer, M.A.; Baulig, W.; Piegeler, T.; Schläpfer, M.; Spahn, D.R.; Falk, V.; Dreessen, P.; Theusinger, O.M.; Schmid, E.R.; et al. Late pharmacologic conditioning with volatile anesthetics after cardiac surgery. Crit. Care 2012, 16, R191. [Google Scholar] [CrossRef] [PubMed]
- Fleisher, L.A.; Beckman, J.A.; Brown, K.A.; Calkins, H.; Chaikof, E.; Fleischmann, K.E.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): Developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 2007, 116, e418–e499. [Google Scholar]
- Sonneville, R.; De Montmollin, E.; Poujade, J.; Garrouste-Orgeas, M.; Souweine, B.; Darmon, M.; Mariotte, E.; Argaud, L.; Barbier, F.; Goldgran-Toledano, D.; et al. Potentially modifiable factors contributing to sepsis-associated encephalopathy. Intensive Care Med. 2017, 43, 1075–1084. [Google Scholar] [CrossRef]
- Mazeraud, A.; Pascal, Q.; Verdonk, F.; Heming, N.; Chrétien, F.; Sharshar, T. Neuroanatomy and physiology of brain dysfunction in sepsis. Clin. Chest Med. 2016, 37, 333–345. [Google Scholar] [CrossRef]
- Ely, E.W.; Shintani, A.; Truman, B.; Speroff, T.; Gordon, S.M.; Harrell, F.E.; Inouye, S.K.; Bernard, G.R.; Dittus, R.S. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004, 14, 1753–1762. [Google Scholar] [CrossRef] [PubMed]
- Girard, T.D.; Thompson, J.L.; Pandharipande, P.P.; Brummel, N.; Jackson, J.C.; Patel, M.B.; Hughes, C.G.; Chandrasekhar, R.; Pun, B.T.; Boehm, L.M.; et al. Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: A prospective cohort study. Lancet Respir. Med. 2018, 6, 213–222. [Google Scholar] [CrossRef] [PubMed]
- Lee, H.; Choi, S.; Jang, E.J.; Lee, J.; Kim, D.; Yoo, S.; Oh, S.Y.; Ryu, H.G. Effect of Sedatives on in-hospital and long- term mortality of critically ill patients requiring extended mechanical ventilation for > 48 hours. J. Korean Med. Sci. 2021, 36, e221. [Google Scholar] [CrossRef]
- Park, S.Y.; Lee, H.B. Prevention and management of delirium in critically ill adult patients in the intensive care unit: A review based on the 2018 PADIS guidelines. Acute Crit. Care 2019, 34, 117–125. [Google Scholar] [CrossRef] [PubMed]
- Devlin, J.W.; Skrobik, Y.; Gélinas, C.; Needham, D.M.; Slooter, A.J.C.; Pandharipande, P.P.; Watson, P.L.; Weinhouse, G.L.; Nunnally, M.E.; Rochwerg, B.; et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit. Care Med. 2018, 46, e825–e873. [Google Scholar] [CrossRef]
- Gurnani, P.K.; Barlow, B.; Boling, B.; Busse, L.W.; Diaz-Gomez, J.L.; Ford, J.; Gibson, G.A.; Khanna, A.K.; Lee, J.S.; Rivosecchi, R.M.; et al. Major Publications in the Critical Care Pharmacotherapy Literature: 2022. Crit. Care Explor. 2023, 22, e0981. [Google Scholar] [CrossRef] [PubMed]
- Lewis, K.; Alshamsi, F.; Carayannopoulos, K.L.; Granholm, A.; Piticaru, J.; Al Duhailib, Z.; Chaudhuri, D.; Spatafora, L.; Yuan, Y.; Centofanti, J.; et al. Dexmedetomidine vs other sedatives in critically ill mechanically ventilated adults: A systematic review and meta-analysis of randomized trials. Intensive Care Med. 2022, 48, 811–840. [Google Scholar] [CrossRef] [PubMed]
- Tokuda, R.; Nakamura, K.; Takatani, Y.; Tanaka, C.; Kondo, Y.; Ohbe, H.; Kamijo, H.; Otake, K.; Nakamura, A.; Ishikura, H.; et al. Sepsis-Associated Delirium: A Narrative Review. J. Clin. Med. 2023, 6, 1273. [Google Scholar] [CrossRef] [PubMed]
- Bauer, T.M.; Ritz, R.; Haberthur, C.; Ha, H.R.; Hunkeler, W.; Sleight, A.J.; Scollo-Lavizzari, G.; Haefeli, W.E. Prolonged sedation due to accumulation of conjugated metabolites of midazolam. Lancet 1995, 15, 145–147. [Google Scholar] [CrossRef]
- Smeets, T.J.L.; de Geus, H.R.H.; Valkenburg, A.J.; Baidjoe, L.; Gommers, D.A.M.P.J.; Koch, B.C.P.; Hunfeld, N.G.M.; Endeman, H. The Clearance of Midazolam and Metabolites during Continuous Renal Replacement Therapy in Critically Ill Patients with COVID-19. Blood Purif. 2023, 3, 1–7. [Google Scholar] [CrossRef] [PubMed]
- Zhang, H.T.; Cheng, S.W.; Peng, L.; Wu, G.P.; Liang, J.X.; Fu, J.W.; Wang, G.Y.; Chen, Z.J.; Lü, C.Z. Application of propofol sedation in patients undergoing continuous venous-venous haemodiafiltration. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2013, 25, 408–410. [Google Scholar]
- Eddleston, J.M.; Pollard, B.J.; Blades, J.F.; Doran, B. The use of propofol for sedation of critically ill patients undergoing haemodiafiltration. Intensive Care Med. 1995, 21, 342–347. [Google Scholar] [CrossRef]
- Abramovitz, B.W.; Oguntuwase, E.; Abo-Zed, A.; DeSilva, R. Hypertriglyceridemia as a Cause of Continuous Renal Replacement Therapy Circuit Clotting: A Case Series. Blood Purif. 2023, 52, 352–358. [Google Scholar] [CrossRef] [PubMed]
- Cheng, V.; Abdul-Aziz, M.H.; Roberts, J.A.; Shekar, K. Optimising drug dosing in patients receiving extracorporeal membrane oxygenation. J. Thorac. Dis. 2018, 10 (Suppl. S5), S629–S641. [Google Scholar] [CrossRef] [PubMed]
- Patel, M.; Altshuler, D.; Lewis, T.C.; Merchan, C.; Smith, D.E., 3rd; Toy, B.; Zakhary, B.; Papadopoulos, J. Sedation Requirements in Patients on Venovenous or Venoarterial Extracorporeal Membrane Oxygenation. Ann. Pharmacother. 2020, 54, 122–130. [Google Scholar] [CrossRef] [PubMed]
- Fuchita, M.; Blaine, C.; Keyworth, A.; Morfin, K.; Primi, B.; Ridgeway, K.; Stake, N.; Watson, H.; Matlock, D.; Mehta, A.B. Perspectives on sedation among interdisciplinary team members in ICU: A survey study. Crit. Care Explor. 2023, 5, e972. [Google Scholar] [CrossRef]
- Chi, X.; Pan, J.; Cai, J.; Luo, G.; Li, S.; Yuan, D.; Rui, J.; Chen, W.; Hei, Z. Pharmacokinetic Analysis of Propofol Target-Controlled Infusion Models in Chinese Patients with Hepatic Insufficiency. Med. Sci. Monit. 2018, 30, 6925–6933. [Google Scholar] [CrossRef]
Monitoring Sedoanalgesia | ||
---|---|---|
Pain | Clinical scales | VAS (Self-reported VNS (Self-reported) |
BPS (not self-reported) CPOT (not self-reported) | ||
Analgesia monitoring | NOL ANI | |
Sedation | Clinical scales | SAS RASS |
Inhaled sedation | MAC-awake | |
Sedation monitoring | BIS (only as an alternative) | |
Delirium | Clinical scales | CAM-ICU ICDSC |
Delirium monitoring | CCEEG or timely EEG |
Clinical Condition Accompanying Sepsis | |||||||
---|---|---|---|---|---|---|---|
ARDS without Difficulty Ventilating | ARDS with Difficulty Ventilating | Myocardial Dysfunction | Renal Insufficiency | Hepatic Insufficiency | Delirium | Notes | |
Propofol | Option C * | Option A (1) | Option A (2) | Option A (3) | Option B (4) | Option A (5) | Look out for signs of PRIS as from 48 h. Adjust for fats in PN. |
Isoflurane | Option A | Option B * | Option B * | Option B * | Option A (6) | Option B (7) | Requires ETI. Monitor end-tidal volume if possible. |
Sevoflurane | Option B ** | Option C *;** | Option C * | Not indicated | Option C ** | Option C ** | |
DEX | Not indicated if deep sedation required | Option C | Option C *** | Option A (8) | May be administered to regulate sleep. | ||
Notes | May be possible to administer intravenous propofol in conjunction with an inhalation agent where deep sedation is indicated. |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Marcos-Vidal, J.M.; González, R.; Merino, M.; Higuera, E.; García, C. Sedation for Patients with Sepsis: Towards a Personalised Approach. J. Pers. Med. 2023, 13, 1641. https://doi.org/10.3390/jpm13121641
Marcos-Vidal JM, González R, Merino M, Higuera E, García C. Sedation for Patients with Sepsis: Towards a Personalised Approach. Journal of Personalized Medicine. 2023; 13(12):1641. https://doi.org/10.3390/jpm13121641
Chicago/Turabian StyleMarcos-Vidal, José Miguel, Rafael González, María Merino, Eva Higuera, and Cristina García. 2023. "Sedation for Patients with Sepsis: Towards a Personalised Approach" Journal of Personalized Medicine 13, no. 12: 1641. https://doi.org/10.3390/jpm13121641