Analgesia and sedation in high-risk critically ill patients: still waiting for evidence about remifentanil

Mistraletti G., Cerri B.

Minerva Anestesiologica, 78(1): 7-9


Critically ill patients requiring invasive vital support such as mechanical ventilation almost uniformly show anxiety, agitation and pain during their ICU stay. The use of analgesic and sedative drugs is essential to improve comfort, reduce anxiety and facilitate nursing care, despite the fact that these drugs present several side effects.
In the past decades, liberal doses of propofol and benzodiazepines were used to keep patients adapted to the harsh ICU environment through deep levels of sedation. Recently, evidence based medicine has shown that heavy sedation may increase mortality and morbidity: new protocols have been proposed to change this cultural approach. Spontaneous awakening and breathing trial, early mobility and physical therapy, analgesia-based sedation, the use of newer drugs with favourable pharmacokinetics6 and the use of an enteral approach are the most important recent innovations. They all share the new target of maximizing comfort and adaptation to invasive procedures while patients remain awake, interactive, and oriented.
High-risk critically ill patients are the most difficult ICU population to take care of, for which any therapeutic intervention could have a significant role in changing the outcome.


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