Complications from long-term deep sedation and the lack of adequate pain control for mechanically ventilated intensive care unit (ICU) patients has resulted in the development of sedation protocols emphasizing pain control over sedation. These protocols use either remifentanyl or fentanyl.
This study was a small retrospective cohort study of 144 adult medical ICU patients intubated before and after the implementation of a fentanyl-based ventilator sedation protocol.
Patients who were intubated for more than 24 hours and qualified for lighter levels of sedation were included. The historical control group was managed with propofol-based sedation strategy to achieve a Richmond Agitation-Sedation Scale (RASS) score between 0 and −2. The intervention group was managed with bolus or infusion fentanyl (supplemented with sedative agents if needed) with the same goal RASS score. The primary outcome was the duration of mechanical ventilation.
The fentanyl-based sedation group had an average 45-hour reduction in ventilator time compared with the propofol-based sedation group. The results of this study are encouraging and certainly warrant a large randomized, control trial for confirmation.
- Faust AC et al. Impact of an analgesia-based sedation protocol on mechanically ventilated patients in a medical intensive care unit. Anesth Analg 2016 Aug 2; [e-pub]. (http://dx.doi.org/10.1213/ANE.0000000000001393)