Article révisé par les pairs
| Résumé : | Sedation and analgesia are important components of the treatment of mechanically ventilated critically ill patients. There is currently a wide variety of pharmacological agents available for the diverse needs of this heterogeneous group of patients. In European ICU, sedation is obtained in 98% of the cases by using, either midazolam, or propofol, and analgesia in 90% of the cases by using, either morphine, fentanyl, or sufentanil. Delirium is most often controlled by using butyrophenones. The first step of sedative and analgesic administration is to define the specific problem requiring sedation and/or analgesia (pain, agitation or delirium, anxiety, inadequate adaptation to the ventilator), to estimate the duration of the treatment, and to rationally choose the drug and depth of sedation appropriate for the indication. Thereafter, the clinician, must recognize the diverse effects of organ dysfunction (mainly hepatic and renal insufficiency) on drug pharmacokinetics and pharmacodynamics. Failure to recognize these effects may lead to inadequate sedation and/or analgesia, and drug accumulation with unnecessary prolonged mechanical ventilation and increased length of stay in the ICU. Daily interruption of continuous sedative and/or analgesic infusion is a simple and effective way of managing this problem and allows a reliable clinical examination of the patient. © 2003 Éditions scientifiques et médicales Elsevier SAS. All rights reserved. |
