Benzodiazepine Versus Nonbenzodiazepine-Based Sedation for Mechanically Ventilated, Critically Ill Adults

Fraser, Gilles L.; Devlin, John W.; Worby, Craig P.; Alhazzani, Waleed; Barr, Juliana; Dasta, Joseph F.; Kress, John P.; Davidson, Judy E.; Spencer, Frederick A.

doi:10.1097/ccm.0b013e3182a16898

Cited by 255 publications

(175 citation statements)

References 40 publications

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“…Several reasons may explain the difference in findings on mortality between our study and the meta-analysis by Fraser et al [3]. One possibility is the fundamental difference in data source: while the meta-analysis involved pooled data from six papers, our study used a multi-center database.…”

Section: Abstract Propofol · Benzodiazepines · Mechanical Ventilationmentioning

confidence: 74%

In Reply: Sedation choices and mortality: a well-defined tandem?

2017

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Section: Abstract Propofol · Benzodiazepines · Mechanical Ventilationmentioning

confidence: 74%

In Reply: Sedation choices and mortality: a well-defined tandem?

2017

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“…3 The choice of the ideal sedative agent is difficult, and must take into account the pharmacology of the drugs and the different pathologies. New studies have shown that the use of benzodiazepines leads to a longer need for ventilatory support (1.9 days, p<0.00001) and longer ICU length of stay (1.65 days, p=0.0005), as demonstrated by a review and meta-analysis by Fraser et al 29,39 Also, it was shown that the prevalence of delirium, in the use of nonbenzodiazepine agents, is lower, implicating in smaller hospitalization cost. 29,40 Recently, the preferential use of non-benzodiazepine sedatives, such as dexmedetomidine and propofol, has been advocated based on the Pain, Agitation and Delirium (PAD) guidelines for adult patients.…”

Section: Resultsmentioning

confidence: 98%

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Motta

Luglio²,

Delgado

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

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“…A recent meta-analysis by Fraser and colleagues [2] also compared these sedation strategies and demonstrated similar results. However, the latter did not demonstrate a significant difference in mortality.…”

Section: Abstract Sedation · Propofol · Benzodiazepines · Mechanical mentioning

confidence: 84%

Sedation choices and mortality: a well-defined tandem?

2016

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The data by Hayashida and colleagues offer valuable new clinical insight into ICU sedation strategies by suggesting that the choice of sedative may influence patient outcomes. However, it is not apparent if this effect is independent of the depth of sedation. Nevertheless, we eagerly await these author's future study results. For further discussion, we consider the work of Shehabi and colleagues [3], which demonstrated that early sedation depth independently predicts increased 180-day mortality in mechanically ventilated ICU patients. Propofol and midazolam were used at the same frequency during the first 48 h, the critical early period. Although the dosage of sedatives cannot be interpolated from the data, it is interesting to consider the role of the choice of sedation in the sedation depth.This comment refers to the article available at

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Benzodiazepine Versus Nonbenzodiazepine-Based Sedation for Mechanically Ventilated, Critically Ill Adults

Cited by 255 publications

References 40 publications

In Reply: Sedation choices and mortality: a well-defined tandem?

In Reply: Sedation choices and mortality: a well-defined tandem?

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Sedation choices and mortality: a well-defined tandem?

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