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Pulmonary
Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study
Taehee Kim, Jung Soo Kim, Eun Young Choi, Youjin Chang, Won-Il Choi, Jae-Joon Hwang, Jae Young Moon, Kwangha Lee, Sei Won Kim, Hyung Koo Kang, Yun Su Sim, Tai Sun Park, Seung Yong Park, Sunghoon Park, Jae Hwa Cho
Acute Crit Care. 2020;35(4):255-262.   Published online November 9, 2020
DOI: https://doi.org/10.4266/acc.2020.00164
Correction in: Acute Crit Care 2021;36(2):172
  • 6,300 View
  • 232 Download
  • 7 Web of Science
  • 7 Crossref
AbstractAbstract PDF
Background
The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs.
Methods
Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included.
Results
A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups.
Conclusions
In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

Citations

Citations to this article as recorded by  
  • Sedation and analgesia strategies for non-invasive mechanical ventilation: A systematic review and meta-analysis
    Baolu Yang, Leyi Gao, Zhaohui Tong
    Heart & Lung.2024; 63: 42.     CrossRef
  • Effect of Music Therapy and Sound Isolation on the Comfort of Mechanically Ventilated Patients
    Sinem Çalışkan, Esra Akın, Mehmet Uyar
    Turkish Journal of Intensive Care.2024; 22(1): 83.     CrossRef
  • 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit
    Yijun Seo, Hak-Jae Lee, Eun Jin Ha, Tae Sun Ha
    Acute and Critical Care.2022; 37(1): 1.     CrossRef
  • Comfort During Non-invasive Ventilation
    Gianmaria Cammarota, Rachele Simonte, Edoardo De Robertis
    Frontiers in Medicine.2022;[Epub]     CrossRef
  • Current status of treatment of acute respiratory failure in Korea
    Yong Jun Choi, Jae Hwa Cho
    Journal of the Korean Medical Association.2022; 65(3): 124.     CrossRef
  • Treatment of acute respiratory failure: noninvasive mechanical ventilation
    Sunghoon Park
    Journal of the Korean Medical Association.2022; 65(3): 144.     CrossRef
  • Dexmedetomidine-Induced Aortic Contraction Involves Transactivation of the Epidermal Growth Factor Receptor in Rats
    Soo Hee Lee, Seong-Chun Kwon, Seong-Ho Ok, Seung Hyun Ahn, Sung Il Bae, Ji-Yoon Kim, Yeran Hwang, Kyeong-Eon Park, Mingu Kim, Ju-Tae Sohn
    International Journal of Molecular Sciences.2022; 23(8): 4320.     CrossRef
Pharmacology
The Optimal Dose of Midazolam for Promoting Sleep in Critically Ill Patients: A Pilot Study
Se Joong Kim, Jisoo Park, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon Taek Lee, Young Jae Cho
Korean J Crit Care Med. 2014;29(3):166-171.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.166
  • 15,474 View
  • 99 Download
  • 4 Crossref
AbstractAbstract PDF
BACKGROUND
Many critically ill patients treated in the intensive care unit (ICU) experience sleep disruption. Midazolam is commonly used for the sedation of critically ill patients. This pilot study is aimed to identify the optimal dose of midazolam for achieving sound sleep in critically ill patients.
METHODS
This prospective study was conducted in the medical ICU of a tertiary referral hospital. Polysomnography recording was performed over 24 hours to assess the quantity and quality of sleep in patients sedated with midazolam.
RESULTS
A total of five patients were enrolled. Median total sleep time was 494.0 (IQR: 113.5-859.0) min. The majority of sleep was stage 1 (median 82.0 [IQR 60.5-372.5] min) and 2 (median 88.0 [60.5-621.0] min) with scant REM (median 10.0 [6.0-50.5] min) and no stage 3 (0.0 min) sleep. The median number of wakings in 1 hour was 16.1 (IQR: 7.6-28.6). The dose of midazolam showed a positive correlation with total sleep time (r = 0.975, p = 0.005).
CONCLUSIONS
The appropriate quantity of sleep in critically ill patients was achieved with a continuous infusion of 0.02-0.03 mg/kg/h midazolam. However, the quality of sleep was poor. Further study is required for the promotion of quality sleep in such patients.

Citations

Citations to this article as recorded by  
  • Effect of prolonged sedation with dexmedetomidine, midazolam, propofol, and sevoflurane on sleep homeostasis in rats
    Brian H. Silverstein, Anjum Parkar, Trent Groenhout, Zuzanna Fracz, Anna M. Fryzel, Christopher W. Fields, Amanda Nelson, Tiecheng Liu, Giancarlo Vanini, George A. Mashour, Dinesh Pal
    British Journal of Anaesthesia.2024; 132(6): 1248.     CrossRef
  • Reliability of the Korean version of the Richards-Campbell Sleep Questionnaire
    Jae Kyoung Kim, Ju-Hee Park, Jaeyoung Cho, Sang-Min Lee, Jinwoo Lee
    Acute and Critical Care.2020; 35(3): 164.     CrossRef
  • Pharmacological interventions to improve sleep in hospitalised adults: a systematic review
    Salmaan Kanji, Alexandru Mera, Brian Hutton, Lisa Burry, Erin Rosenberg, Erika MacDonald, Vanessa Luks
    BMJ Open.2016; 6(7): e012108.     CrossRef
  • Sedation in Critically Ill Patients
    Mark Oldham, Margaret A. Pisani
    Critical Care Clinics.2015; 31(3): 563.     CrossRef
Multicenter Prospective Observational Study about the Usage Patterns of Sedatives, Analgesics and Neuromuscular Blocking Agents in the Patients Requiring More Than 72 Hours Mechanical Ventilation in Intensive Care Units of Korea
Hang Jea Jang, Seung Won Ra, Bum Jin Oh, Chae Man Lim, Younsuck Koh, Sang Bum Hong
Korean J Crit Care Med. 2009;24(3):145-151.
DOI: https://doi.org/10.4266/kjccm.2009.24.3.145
  • 2,753 View
  • 47 Download
  • 3 Crossref
AbstractAbstract PDF
BACKGROUND
To investigate the usage patterns of sedatives, analgesics and neuromuscular blocking agents (NMBAs) in patients requiring mechanical ventilation more than 72 hours in intensive care units (ICUs) of Korea.
METHODS
A total of 536 patients continuing mechanical ventilation more than 72 hours had been enrolled among the twenty-one ICUs of Korea from May 2003 to July 2003. Data about mechanical ventilation, the use of sedatives, analgesics, and NMBAs were prospectively collected for four weeks. We analyzed the patterns of using these drugs and effects on outcomes.
RESULTS
More than half of the patients (50.4%) received sedative drug alone. Most commonly used sedatives and analgesics were midazolam and morphine. NMBAs were administered in 41% of the patients. Volume controlled ventilation mode was associated with more frequent use of NMBAs. There were no significant differences in outcome variables among the usage patterns of sedatives, analgesics and NMBAs.
CONCLUSIONS
Our investigation shows that analgesics were much less frequently used in the intensive care units of Korea compared with the use of sedatives. And the use of NMBAs were quite a common.

Citations

Citations to this article as recorded by  
  • Change in management and outcome of mechanical ventilation in Korea: a prospective observational study
    Jae Kyeom Sim, Sang-Min Lee, Hyung Koo Kang, Kyung Chan Kim, Young Sam Kim, Yun Seong Kim, Won-Yeon Lee, Sunghoon Park, So Young Park, Ju-Hee Park, Yun Su Sim, Kwangha Lee, Yeon Joo Lee, Jin Hwa Lee, Heung Bum Lee, Chae-Man Lim, Won-Il Choi, Ji Young Hong
    The Korean Journal of Internal Medicine.2022; 37(3): 618.     CrossRef
  • Pressure Ulcer Prevalence and Risk Factors at the Time of Intensive Care Unit Admission
    Hye Ran Kwak, Jiyeon Kang
    Korean Journal of Adult Nursing.2015; 27(3): 347.     CrossRef
  • Clinical Demographics and Outcomes in Mechanically Ventilated Patients in Korean Intensive Care Units
    Byeong-Ho Jeong, Gee Young Suh, Jin Young An, Moo Suk Park, Jin Hwa Lee, Myung-Goo Lee, Je Hyeong Kim, Yun Seong Kim, Hye Sook Choi, Kyung Chan Kim, Won-Yeon Lee, Younsuck Koh
    Journal of Korean Medical Science.2014; 29(6): 864.     CrossRef

ACC : Acute and Critical Care