1. Analgesia and sedation in patients with ARDS
- Author
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Timothy D. Girard, Yahya Shehabi, Bram Rochwerg, Bhakti K. Patel, Sangeeta Mehta, Samir Jaber, Thomas Langer, Jean François Payen, Hanne T. Olsen, John P. Kress, Claude Guérin, Gilles L. Fraser, E. Wesley Ely, Thomas Strøm, Michael J. Murray, John W. Devlin, Kathleen Puntillo, Jean-Michel Constantin, Matthieu Jabaudon, Gerald Chanques, Céline Gélinas, Pratik P. Pandharipande, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Northeastern University [Boston], Brigham & Women’s Hospital [Boston] (BWH), Harvard Medical School [Boston] (HMS), Vanderbilt University Medical Center [Nashville], Vanderbilt University [Nashville], Tufts University School of Medicine [Boston], McGill University = Université McGill [Montréal, Canada], Lady Davis Institute for Medical Research [Montréal], McGill University = Université McGill [Montréal, Canada]-Jewish General Hospital, University of Pittsburgh School of Medicine, Pennsylvania Commonwealth System of Higher Education (PCSHE), Université de Lyon, Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Génétique, Reproduction et Développement (GReD ), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), CHU Clermont-Ferrand, University of Toronto, Università degli Studi di Milano-Bicocca [Milano] (UNIMIB), ASST Grande Ospedale Metropolitano Niguarda, University of Arizona, University of Chicago, CHU Grenoble, [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), University of California [San Francisco] (UCSF), University of California, McMaster University [Hamilton, Ontario], Monash University [Clayton], University of New South Wales [Sydney] (UNSW), Odense University Hospital, Odense C, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), University of California [San Francisco] (UC San Francisco), University of California (UC), Chanques, G, Constantin, J, Devlin, J, Ely, E, Fraser, G, Gelinas, C, Girard, T, Guerin, C, Jabaudon, M, Jaber, S, Mehta, S, Langer, T, Murray, M, Pandharipande, P, Patel, B, Payen, J, Puntillo, K, Rochwerg, B, Shehabi, Y, Strom, T, Olsen, H, Kress, J, and MORNET, Dominique
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medicine.medical_specialty ,ARDS ,Sedation ,medicine.medical_treatment ,Pain medicine ,[SDV]Life Sciences [q-bio] ,Remifentanil ,Guidelines as Topic ,Review ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,Mechanical ventilation ,0302 clinical medicine ,law ,Anesthesiology ,medicine ,Humans ,Hypnotics and Sedatives ,Pain Management ,Intensive care unit ,MED/41 - ANESTESIOLOGIA ,Intensive care medicine ,ComputingMilieux_MISCELLANEOUS ,Respiratory Distress Syndrome ,Acute respiratory distress syndrome ,business.industry ,Rehabilitation ,COVID-19 ,030208 emergency & critical care medicine ,medicine.disease ,3. Good health ,[SDV] Life Sciences [q-bio] ,030228 respiratory system ,Delirium ,Analgesia ,medicine.symptom ,business ,medicine.drug - Abstract
Acute Respiratory Distress Syndrome (ARDS) is one of the most demanding conditions in an Intensive Care Unit (ICU). Management of analgesia and sedation in ARDS is particularly challenging. An expert panel was convened to produce a “state-of-the-art” article to support clinicians in the optimal management of analgesia/sedation in mechanically ventilated adults with ARDS, including those with COVID-19. Current ICU analgesia/sedation guidelines promote analgesia first and minimization of sedation, wakefulness, delirium prevention and early rehabilitation to facilitate ventilator and ICU liberation. However, these strategies cannot always be applied to patients with ARDS who sometimes require deep sedation and/or paralysis. Patients with severe ARDS may be under-represented in analgesia/sedation studies and currently recommended strategies may not be feasible. With lightened sedation, distress-related symptoms (e.g., pain and discomfort, anxiety, dyspnea) and patient-ventilator asynchrony should be systematically assessed and managed through interprofessional collaboration, prioritizing analgesia and anxiolysis. Adaptation of ventilator settings (e.g., use of a pressure-set mode, spontaneous breathing, sensitive inspiratory trigger) should be systematically considered before additional medications are administered. Managing the mechanical ventilator is of paramount importance to avoid the unnecessary use of deep sedation and/or paralysis. Therefore, applying an “ABCDEF-R” bundle (R = Respiratory-drive-control) may be beneficial in ARDS patients. Further studies are needed, especially regarding the use and long-term effects of fast-offset drugs (e.g., remifentanil, volatile anesthetics) and the electrophysiological assessment of analgesia/sedation (e.g., electroencephalogram devices, heart-rate variability, and video pupillometry). This review is particularly relevant during the COVID-19 pandemic given drug shortages and limited ICU-bed capacity.
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- 2020