Bittner_Manual medicina intensiva del MGH.7ed

Capítulo 7 Sedación y analgesia

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C. La necesidad de parálisis química debe reevaluarse cada 12 horas, idealmente du rante las rondas multidisciplinarias. Si la hipoxemia del paciente mejora, se debe intentar suspender la infusión de cisatracurio. Si reaparece la asincronía pacien te-ventilador, puede restablecerse el bloqueo neuromuscular. Una vez que el bloqueo neuromuscular ya no esté indicado, debe suspenderse con rapidez y, en consecuen cia, el nivel de sedación debe aligerarse o reducirse. Lecturas seleccionadas Baumgartner L, Lam K, Lai J, et al. Effectiveness of melatonin for the prevention of intensive care unit delirium. Pharmacotherapy . 2019;39(3):280-287. Block BM, Liu SS, Rowlingson AJ, et al. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA. 2003;290:2455-2463. Carson SS, Kress JP, Rodgers JE, et al. A randomized trial of intermittent lorazepam ver sus propofol with daily interruption in mechanically ventilated patients. Crit Care Med. 2006;34(5):1326-1332. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomized controlled trial. Lancet. 2008;371:126-134. Hanidziar D, Baldyga K, Ji CS, et al. Standard sedation and sedation with isoflurane in mechan ically ventilated patients with coronavirus disease 2019. Crit Care Explor . 2021;3(3):e0370. Hughes CG, Mailloux PT, Devlin JW, et al. Dexmedetomidine or propofol for sedation in me chanically ventilated adults with sepsis. N Engl J Med . 2021;384(15):1424-1436. Hughes MA, Glass PS, Jacobs JR. Context-sensitive half-time in multicompartment pharmaco kinetic models for intravenous anesthetic drugs. Anesthesiology. 1992;76:334–341. Kress JP, Pohlman AS, O’Connor M, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471-1477. Lonardo NW, Mone MC, Nirula R, et al. Propofol is associated with favorable outcomes com pared with benzodiazepines in ventilated intensive care unit patients. Am J Respir Crit Care Med. 2014;189(11):1383-1394. Martyn JAJ, Mao J, Bittner EA. Opioid tolerance in critical illness. N Engl J Med . 2019;380(4): 365-378. Mehta S, Cook D, Devlin JW, et al. Prevalence, risk factors, and outcomes of delirium in mechan ically ventilated adults. Crit Care Med. 2015;43(3):557-566. Mikkelsen ME, Christie JD, Lanken PN, et al. The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med. 2012;185(12):1307-1315. Olsen HT, Nedergaard HK, Strøm T, et al. Nonsedation or light sedation in critically ill, mechan ically ventilated patients. N Engl J Med. 2020;382(12):1103-1111. Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs loraze pam on acute brain dysfunction in mechanically ventilated patients: the MENDS random ized controlled trial. JAMA. 2007;298:2644-2653. Reade MC, Finfer S. Sedation and delirium in the intensive care unit. N Engl J Med. 2014; 370(5):444-454. Riker RR, Shehabi Y, Bokesh PM, et al. Dexmedetomidine vs. midazolam for sedation of criti cally ill patients. JAMA. 2009;301:489-499. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized controlled trial. Lancet. 2009;373(9678):1874-1882. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond agitation-sedation scale: validity and re liability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166:1338-1344. Shehabi Y, Howe BD, Bellomo R, et al. Early sedation with dexmedetomidine in critically ill patients. N Engl J Med . 2019;380(26):2506-2517. Sigakis MJ, Bittner EA. Ten myths and misconceptions regarding pain management in the ICU. Crit Care Med. 2015;43(11):2468-2478. Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010;375(9713):475-480. Wongtangman K, Grabitz SD, Hammer M, et al. Optimal sedation in patients who receive neuromuscular blocking agent infusions for treatment of acute respiratory distress syndrome-A retrospective cohort study from a New England Health Care Network. Crit Care Med . 2021;49(7):1137-1148.

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