RT Book, Section
A1 Kress, John P.
A1 Hall, Jesse B.
A2 Tobin, Martin J.
SR Print(0)
ID 57077812
T1 Chapter 50. Pain Control, Sedation, and Neuromuscular Blockade
T2 Principles and Practice of Mechanical Ventilation, 3e
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-173626-8
LK accessmedicine.mhmedical.com/content.aspx?aid=57077812
RD 2024/04/18
AB Mechanically  ventilated  patients  often  require  sedatives  and  analgesics,  and  in  some  circumstances  may  even  require  the  addition  of  neuromuscular  blockade.  The  myriad  disease  processes  causing  respiratory  failure  frequently  elicit  a  sense  of  respiratory  distress  in  these  patients.  In  addition,  therapies  such  as  endotracheal  intubation  and  positive-pressure  ventilation  bring  about  discomfort  to  a  significant  number  of  patients  in  the  intensive  care  unit  (ICU),  and  patients  often  receive  these  life  support  treatments  after  surgical  interventions  or  medical  conditions  that  themselves  carry  a  burden  of  pain.  Accordingly,  most  patients  receive  analgesics  and/or  sedatives  while  undergoing  mechanical  ventilation.  Although  many  drugs  are  available  to  carry  out  the  goals  of  pain  control  and,  if  necessary,  sedation  in  the  ICU,  studies  of  the  use  of  these  agents  were  initially  performed  in  other  settings  such  as  the  operating  room  or  procedure  suite.  However,  accumulation  of  evidence  directed  at  ICU  patient  outcomes—specifically  patients  undergoing  mechanical  ventilation—has  increased  over  recent  decades,  and  awareness  of  the  complex  pharmacology  of  sedatives  and  analgesics  in  critical  care  is  now  well  established.  At  the  same  time,  heightened  awareness  of  the  complications  associated  with  the  use  of  neuromuscular  blocking  agents  has  relegated  their  use  to  mostly  short-term  indications,  such  as  general  anesthesia  in  the  operating  room,  with  ICU  use  now  reserved  for  a  small  population  of  patients,  typically  suffering  from  severe  acute  respiratory  distress  syndrome.  The  drugs  used  to  achieve  analgesia  and  sedation  of  mechanically  ventilated  patients  are  necessarily  potent;  however,  the  enduring  effects  when  these  drugs  are  used  without  discretion  has  impacted  strategies  for  their  administration.