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Erschienen in:
01.03.2005 | Brief Report
Sedation in the critically ill ventilated patient: possible role of enteral drugs
Erschienen in: Intensive Care Medicine | Ausgabe 3/2005
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Objective
Sedation by the enteral route is unusual in intensive medicine. We analysed the feasibility/efficacy of long-term enteral sedation in ventilated critically ill patients.
Design
Prospective interventional cohort study.
Setting
General ICU.
Patients and participants
Forty-two patients needing ventilation and sedation for at least 4 days.
Interventions
At admission, sedation was induced with propofol or midazolam. Enteral hydroxyzine (± enteral lorazepam) was added in all patients within the second day. Intravenous drugs were gradually withdrawn, trying to maintain only enteral sedation after the initial 48 h. Analgesia was provided with continuous IV fentanyl.
Measurements and results
Sedation level was assessed evaluating, on a daily basis, patients’ compliance to the invasive care and comparing observed vs planned Ramsay scores three times a day. Excluding the first 2 days of patient-stabilisation and fast titration of sedation level, 577 days with ventilatory support were analysed. In 460 days (79.7%) total enteral sedation was given. This percentage rose to 94.2% when the requested Ramsay was 2 (347 days). Daily sedation was judged as adequate in 82.8% of days of total enteral sedation. Thirty-one patients had total enteral as the exclusive route of sedation.
Conclusions
After 24–48 h, enteral sedation may replace, totally/in part, IV sedation in ventilated patients. Total enteral sedation easily fits the target when a Ramsay score 2 is planned. When a deeper sedation is needed, a mixed regimen is effective and lowers IV drug dosages. No side effects were reported.