Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Post-intensive Care Syndrome
- Prevention of Physical and Psychosocial Consequences Following Critical Care Admission
- Structured Rehabilitation Plans
- Long-Term Follow-Up
- Cost Implications
- Introduction
- Importance of Pain Management
- Pain Aetiology in the ICU
- Assessment of Pain in the ICU
- Management
- Procedural Pain
- Sedation
- Neuromuscular Blockade
- Assessment of ICU-AW
- Prevention and Rehabilitation of ICU-AW
- The ABCDEF Bundle
- Rehabilitation after Critical Illness
- Conclusion
- Introduction
- What is Meant by Recovery after Critical Illness?
- Models of Follow-Up Care
- Follow-Up Clinic Consultation
- Follow-Up Clinic Interventions
- Future Directions
- 7.1 How to Identify and Attempt to Minimise the Physical and Psychosocial Consequences of Critical Illness for Patients and Families?
- 7.2 Principles of Assessment, Prevention and Treatment of Pain in Intensive Care
- 7.3 Sedation and Neuromuscular Blockade in Intensive Care
- 7.4 Intensive Care Unit-Acquired Weakness and Physical Rehabilitation
- 7.5 Follow-Up after Critical Illness
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
7.3 - Sedation and Neuromuscular Blockade in Intensive Care
from Section 7 - Comfort and Recovery
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Post-intensive Care Syndrome
- Prevention of Physical and Psychosocial Consequences Following Critical Care Admission
- Structured Rehabilitation Plans
- Long-Term Follow-Up
- Cost Implications
- Introduction
- Importance of Pain Management
- Pain Aetiology in the ICU
- Assessment of Pain in the ICU
- Management
- Procedural Pain
- Sedation
- Neuromuscular Blockade
- Assessment of ICU-AW
- Prevention and Rehabilitation of ICU-AW
- The ABCDEF Bundle
- Rehabilitation after Critical Illness
- Conclusion
- Introduction
- What is Meant by Recovery after Critical Illness?
- Models of Follow-Up Care
- Follow-Up Clinic Consultation
- Follow-Up Clinic Interventions
- Future Directions
- 7.1 How to Identify and Attempt to Minimise the Physical and Psychosocial Consequences of Critical Illness for Patients and Families?
- 7.2 Principles of Assessment, Prevention and Treatment of Pain in Intensive Care
- 7.3 Sedation and Neuromuscular Blockade in Intensive Care
- 7.4 Intensive Care Unit-Acquired Weakness and Physical Rehabilitation
- 7.5 Follow-Up after Critical Illness
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. Goldilocks principle – always aim for just the right amount of sedation, comfort without coma.
2. Use of sedation holds/‘holidays’ can reduce the length of ventilator days.
3. Sedation protocols vary between institutions, but all rely on regular assessment of depth of sedation with standardised scoring systems.
4. Use of neuromuscular blockade in critical care has modest association with neuromuscular dysfunction seen in critical illness weakness.
5. Use of early neuromuscular blockade in moderate to severe acute respiratory distress syndrome has been shown to reduce mortality.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 660 - 662Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Murray, M, DeBlock, H, Erstad, B, et al. Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient. Crit Care Med 2016;44:2079–98.CrossRefGoogle ScholarPubMed
National Heart, Lung, and Blood Institute PETAL Clinical Trials Network; Moss, M, Huang, DT, Brower, RG, et al. Early neuromuscular blockade in the acute respiratory distress syndrome. N Engl J Med 2019;380:1997–2008.Google ScholarPubMed
Price, DR, Mikkelsen, ME, Umscheid, CA, Armstrong, EJ. Neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness: a systematic review and meta-analysis. Crit Care Med 2016;44:2070–8.CrossRefGoogle ScholarPubMed
Shehabi, Y, Howe, BD, Bellomo, R, et al. Early sedation with dexmedetomidine in critically ill patients. N Engl J Med 2019;380:2506–17.CrossRefGoogle ScholarPubMed
Whitehouse, T, Snelson, C, Grounds, M (eds). 2014. Intensive Care Society review of best practice for analgesia and sedation in the critical care. www.ics.ac.uk/Society/Guidance/PDFs/Analgesia_and_SedationGoogle Scholar