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01.03.2014 | Year in Review 2013

Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients

verfasst von: Elie Azoulay, Giuseppe Citerio, Jan Bakker, Matteo Bassetti, Dominique Benoit, Maurizio Cecconi, J. Randall Curtis, Glenn Hernandez, Margaret Herridge, Samir Jaber, Michael Joannidis, Laurent Papazian, Mark Peters, Pierre Singer, Martin Smith, Marcio Soares, Antoni Torres, Antoine Vieillard-Baron, Jean-François Timsit

Erschienen in: Intensive Care Medicine | Ausgabe 3/2014

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Intensive Care Medicine has taken part this year in the ongoing controversy about sedation strategies for the critically ill. Shehabi et al. [1] replicated the ANZ SPICE study design in 11 Malaysian ICUs to assess whether early sedation depth was independently associated with delayed extubation and increased mortality. They performed a prospective multicenter study that included 259 medical/surgical patients who were sedated and ventilated for at least 24 h. Deep sedation, defined as Richmond Agitation Sedation Score (RASS) ≤ −3, occurred in 71 % of patients at first assessment. Multivariable Cox proportional hazard regression analysis adjusting for confounders confirmed that early deep sedation was independently associated with longer time to extubation, hospital and 180-day mortality. Delirium occurred in 114 (44 %) of patients but was not associated with sedation length upon first assessment. The performance and the feasibility of an automated administration of sedation were evaluated in a phase II randomized controlled trial (RCT) by Le Guen et al. [2]. Thirty-one patients were allocated to receive either propofol or remifentanil, through either an automated or a manual system. In the two groups, targeted bispectral index (BIS) values were between 40 and 60. Propofol consumption was reduced by 50 % in the automated group with a median change of infusion rates of 39 ± 9 times per hour compared to only 2 ± 1 propofol dose changes per hour in the manual group. Similarly, the median number of changes in infusion rates was 40 ± 9 for remifentanil in the automated group, compared to 1 ± 1 dose changes per hour in the manual group. In a single-center pilot study of critically ill patients in spontaneous ventilation undergoing flexible fiberoptic bronchoscopy, the safety and efficacy of sedation with remifentanil target-controlled infusion (Remi-TCI) were assessed by Chalumeau-Lemoine et al. [3]. The procedure was successful, comfortable, and safe in all patients. Patients reported low level of pain and good satisfaction with the procedure. …

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Le Guen M, Liu N, Bourgeois E et al (2013) Automated sedation outperforms manual administration of propofol and remifentanil in critically ill patients with deep sedation: a randomized phase II trial. Intensive Care Med 39:454–462. doi:10.1007/s00134-012-2762-2 PubMedCrossRef

Chalumeau-Lemoine L, Stoclin A, Billard V et al (2013) Flexible fiberoptic bronchoscopy and remifentanil target-controlled infusion in ICU: a preliminary study. Intensive Care Med 39:53–58. doi:10.1007/s00134-012-2697-7 PubMedCrossRef

Zaal IJ, Spruyt CF, Peelen LM et al (2013) Intensive care unit environment may affect the course of delirium. Intensive Care Med 39:481–488. doi:10.1007/s00134-012-2726-6 PubMedCrossRef

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Perren A, Brochard L (2013) Managing the apparent and hidden difficulties of weaning from mechanical ventilation. Intensive Care Med 39:1885–1895. doi:10.1007/s00134-013-3014-9 PubMedCrossRef

Sulemanji DS, Marchese A, Wysocki M, Kacmarek RM (2013) Adaptive support ventilation with and without end-tidal CO2 closed loop control versus conventional ventilation. Intensive Care Med 39:703–710. doi:10.1007/s00134-012-2742-6 PubMedCrossRef

Lellouche F, Bouchard P-A, Simard S et al (2013) Evaluation of fully automated ventilation: a randomized controlled study in post-cardiac surgery patients. Intensive Care Med 39:463–471. doi:10.1007/s00134-012-2799-2 PubMedCrossRef

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11.

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12.

Mojoli F, Iotti GA, Curro I et al (2013) An optimized set-up for helmet noninvasive ventilation improves pressure support delivery and patient-ventilator interaction. Intensive Care Med 39:38–44. doi:10.1007/s00134-012-2686-x PubMedCrossRef

13.

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Caldarelli V, Borel JC, Khirani S et al (2013) Polygraphic respiratory events during sleep with noninvasive ventilation in children: description, prevalence, and clinical consequences. Intensive Care Med 39:739–746. doi:10.1007/s00134-012-2806-7 PubMedCrossRef

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Carlucci A, Schreiber A, Mattei A et al (2013) The configuration of bi-level ventilator circuits may affect compensation for non-intentional leaks during volume-targeted ventilation. Intensive Care Med 39:59–65. doi:10.1007/s00134-012-2696-8 PubMedCrossRef

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26.

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27.

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28.

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31.

Hernu R, Wallet F, Thiollière F et al (2013) An attempt to validate the modification of the American-European consensus definition of acute lung injury/acute respiratory distress syndrome by the Berlin definition in a university hospital. Intensive Care Med 39:2161–2170. doi:10.1007/s00134-013-3122-6 PubMedCrossRef

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Villar J, Perez-Mendez L, Blanco J et al (2013) A universal definition of ARDS: the PaO2/FiO(2) ratio under a standard ventilatory setting-a prospective, multicenter validation study. Intensive Care Med 39:583–592. doi:10.1007/s00134-012-2803-x PubMedCrossRef

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Chiumello D, Coppola S, Froio S et al (2013) Time to reach a new steady state after changes of positive end expiratory pressure. Intensive Care Med 39:1377–1385. doi:10.1007/s00134-013-2969-x PubMedCrossRef

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Fernandez R, Gili G, Villagra A et al (2013) Assessment of the inflammatory effect of low-dose oxygen in mechanically ventilated patients. Intensive Care Med 39:711–716. doi:10.1007/s00134-012-2801-z PubMedCrossRef

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41.

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63.

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64.

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Titel: Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients
verfasst von: Elie Azoulay
Giuseppe Citerio
Jan Bakker
Matteo Bassetti
Dominique Benoit
Maurizio Cecconi
J. Randall Curtis
Glenn Hernandez
Margaret Herridge
Samir Jaber
Michael Joannidis
Laurent Papazian
Mark Peters
Pierre Singer
Martin Smith
Marcio Soares
Antoni Torres
Antoine Vieillard-Baron
Jean-François Timsit
Publikationsdatum: 01.03.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 3/2014
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-014-3217-8

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Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients

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