Critically ill patients in intensive care unit (ICU) section regularly experience nervousness and agitation and are at risk of reacting to numerous stressful and fatal stimuli (Dahaba et al, 2004). Consequently, ICU patients require normally require a combination of analgesia and sedation to alleviate their state of nervousness, enhance adjustment to the endotracheal tube, and facilitate conformity to mechanical ventilation (Muellejans et al, 2006). Studies have proposed that analgesia-based sedation using remifentanil reduces the duration of ventilation and period of stay in the ICU compared to a conventional regimen (Battershill and Keating, 2006, Breen et al, 2005, Rozendaal et al, 2009).
This study compared an analgesic sedation regimen with remifentanil against a conventional regimen using midazolam or morphine in patients requiring postoperative mechanical ventilation in the ICU.
A sample of 55 ICU patients with no serious renal conditions (19 to 75 year old) randomly received either a remifentanil (6 doses max. 60 µg kg-1 h-1) sedation regime (n= 27) or a conventional regimen using midazolam (0.02 to 0.2 mg kg-1 h-1) with morphine (n= 28) according to their individual body weights. The randomization procedure was based on a computer generated list. Patients were not informed of the sedation option used.
The remifentanil-based sedation considerably lessened the period of mechanical ventilation by more than 2 days (53.5 hours, P = 0.033).Consequently, the remifentanil-based sedation reduced the duration of stay in the ICU by 1 day. However, ICU stay per patient for the two sedation options were equivalent.
Analgesia-based sedation using remifentanil reduces the duration of mechanical ventilation and ICU stay as compared to conventional regimen using midazolam with morphine.
References
Battershill, A. J. and Keating G. M. (2006). Remifentanil: A Review of its Analgesic and Sedative Use in the Intensive Care Unit. Drugs 2006; 66 (3): 365-385.
Breen, D. et al. (2005). Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients: a randomised trial. Critical Care 2005, 9:R200-R210.
Dahaba,A. A. et al. (2004). Remifentanil versus Morphine Analgesia and Sedation for Mechanically Ventilated Critically Ill Patients. Anesthesiology, V 101, No 3, 640-6.
Muellejans, B. et al. (2006). Sedation in the intensive care unit with remifentanil/propofol versus midazolam/fentanyl: a randomised, open-label, pharmacoeconomic trial. Critical Care 2006, 10:R91.
Rozendaal, F.W. et al. (2009). Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: A centre randomised, cross-over, open-label study in the Netherlands. Intensive Care Medicine, volume 35, issue 2 pp 291-298.