Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000600012
Brazilian Journal of Anesthesiology
Miscellaneous

Experiência clínica com o uso de sedativos em terapia intensiva: estudo retrospectivo

Clinical experience with sedatives in the intensive care unit: a retrospective study

Geraldo Rolim Rodrigues Júnior; José Luiz Gomes do Amaral

http://dx.doi.org/10.1590/S0034-70942002000600012 Braz J Anesthesiol, vol.52, n6, p.747-755, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: Dentre as indicações mais freqüentes de sedação em pacientes internados em Unidades de Terapia Intensiva (UTI) estão a instituição e a manutenção de ventilação artificial, a ansiedade e procedimentos desconfortáveis ou dolorosos. O objetivo deste estudo retrospectivo foi verificar as indicações e as técnicas mais comuns de sedação em pacientes graves internados na Unidade de Terapia Intensiva Cirúrgica da Escola Paulista de Medicina (EPM/UNIFESP) durante um período de 11 meses. MÉTODO: Após terem sido excluídos os pacientes que permaneceram na UTI menos de 24 horas ou estavam sem exames indispensáveis para o cálculo do índice de gravidade (APACHE II), a amostra ficou reduzida a 307 pacientes. Foram analisadas as técnicas mais utilizadas, as indicações de sedação e a associação de bloqueadores neuromusculares. RESULTADOS: A sedação foi administrada em 37,4% dos pacientes. Entre as indicações de sedação estão os distúrbios de natureza psiquiátrica, como delírio, agitação, medo e ansiedade. Estas corresponderam a 25,77% de todas as indicações. A maioria dos pacientes ventilados artificialmente também necessita de sedativos. Instalação e manutenção de ventilação mecânica corresponderam à maioria das indicações, em torno de 57,73% dentre os pacientes sedados. Procedimentos como intubação traqueal e broncoscopia tiveram 11,34% das indicações e controle do metabolismo (coma barbitúrico e tétano), 5,15%. As técnicas mais comumente utilizadas incluíram opióides isolados ou associados a benzodiazepínicos. Neste estudo, o fentanil foi utilizado em 58% das técnicas, isoladamente, e em 21,64% associado ao midazolam. Haloperidol, diazepam, propofol e tiopental somaram 19,5%. Bloqueadores neuromusculares foram utilizados em 22,7% dos casos em pacientes ventilados artificialmente. CONCLUSÕES: A sedação é recurso terapêutico freqüente em Terapia Intensiva, comumente utilizada para facilitar a ventilação artificial e tratar os problemas de natureza psiquiátrica. Fentanil, isoladamente ou em associação com midazolam, foi o agente mais utilizado.

Palavras-chave

SEDAÇÃO, TERAPIA INTENSIVA

Abstract

BACKGROUND AND OBJECTIVES: Among the most frequent indications for Intensive Care Unit patients sedation, one may mention artificial ventilation installation and maintenance, anxiety and uncomfortable or painful procedures. This retrospective study aimed at evaluating most common sedation indications and techniques for severe patients admitted to the Surgical Intensive Care Unit, Escola Paulista de Medicina (EPM/UNIFESP) during an 11-month period. METHODS: After excluding patients remaining in the ICU for less than 24 hours and those without the necessary evaluation to determine their severity index (APACHE II), the sample was reduced to 307 patients. Most common techniques, sedation indications and neuromuscular blockers association were evaluated. RESULTS: Sedation was administered to 37.4% of patients. Psychiatric disorders, such as delirium, agitation, fear and anxiety, were some indications for sedation and corresponded to 25.77% of all indications. Most ventilated patients also needed sedative agents and mechanical ventilation installation and maintenance represented most indications, or approximately 57.73% of all sedated patients. Procedures, such as tracheal intubation and bronchoscopy, represented 11.34% of all indications and metabolic control (barbiturate coma and tetanus) represented 5.15% of the cases. Most common sedative techniques included opioids alone or associated to benzodiazepines. In this study, fentanyl alone was used in 58% of the cases, and fentanyl plus midazolam in 21.64% of patients. Haloperidol, diazepam, propofol and thiopental added up 19.5%. Neuromuscular blockers were used in 22.7% of mechanically in ventilated patients. CONCLUSIONS: Sedation is a common therapeutic resource for intensive care and is widely used to help mechanical ventilation and to treat psychiatric disorders. Fentanyl, alone or in association with midazolam, was the most widely used agent.

Keywords

INTENSIVE CARE, SEDATION

References

Crippen DW. The role of sedation in the ICU patient with pain and agitation. Crit Care Clin. 1990;6:369-372.

Dobb GJ, Murphy DF. Sedation and analgesia during intensive care. Clin Anaesth. 1985;3:1055-1083.

Vinik HR, Kissin I. Sedation in ITU. Intensive Care Med. 1991;17:S20-S23.

Gomes AMCG, Santos PAJ. Humanização em Medicina Intensiva. Clínicas Brasileiras de Medicina Intensiva: Sedação, Analgesia e Bloqueio Neuromuscular em UTI. 1997:13-46.

Tomlim PJ. Psychological problems in intensive care. Br Med J. 1977;2:441-443.

Benzer H, Mutz N, Pauser G. Psychological sequelae of intensive care. Int Anesthesiol Clin. 1983;21:169-180.

Brock-Utne JG, Cheetham RWS, Goodwin NM. Psychiatric problems in intensive care. Anaesthesia. 1976;31:380-384.

Helton MC, Gordon SH, Nunnery SL. The correlation between sleep deprivation and the intensive care unit syndrome. Heart & Lung. 1980;9:464-468.

Mindus P. Anxiety, pain and sedation: some psychiatric aspects. Acta Anaesthesiol Scand. 1987;32(^s88):7-12.

Amaral JLG, Rodrigues Jr GR, Rocha RGA. Sedação. Clínicas Brasileiras de Medicina Intensiva: Sedação, Analgesia e Bloqueio Neuromuscular em UTI. 1997:75-94.

Campos RA, Herraez FXV, Marcos RJ. Drug use in an intensive care unit and this relation to survival. Intensive Care Med. 1980;6:163-168.

Farina ML, LevatI A, Tognoni G. A multi-center study of ICU drug utilization. Intensive Care Med. 1981;7:125-131.

Wallace PGM, Bion JF, Ledingham I.Mc.A. The Changing Face of Sedative Practice. Recent Advances in Critical Care Medicine. 1988;3:70-93.

Berger MM, Marazzi A, Freeman J. Evaluation of the consistency of acute physiology and chronic health evaluation (APACHE II) scoring in a surgical. Intensive Care Unit Crit Care Med. 1992;20:1681-1687.

Siegel S. Estatística no Parametrica. 1975:346.

Bion JF, Chow B, Bowden MI. Aims and methods of assessment of sedation. Intensive Care J Drug Dev. 1991;4(^s3):19-25.

Aitkenhead AR. Analgesia and sedation in intensive care. Br J Anaesth. 1989;63:196-206.

Buchanan N, Cane RD. Drug utilization in a general intensive care unit. Intensive Care Med. 1978;4:75-77.

Easton C, Mackenzie F. Sensory-perceptual alterations: delirium in the intensive care unit. Heart & Lung. 1988;17:229-237.

Cassem EH, Lake CR, Boyer WF. Psychopharmacology in the ICU. The Pharmacological Approach to the Critically ill Patient. 1988:491-510.

Bion JF, Ledingham I.Mc.A. Sedation in intensive care: a postal survey. Intensive Care Med. 1987;13:215-216.

Moritz R, Goldwasser R. Uso de sedativos em unidades de terapia intensivas brasileiras. Rev Bras Terap Intens. 1999;11:139-145.

Shapiro BA, Warren MD, Egol AB. Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Crit Care Med. 1995;23:1596-1600.

Amaral JLG, Réa Neto A, Conceição NA. I Consenso Brasileiro sobre Sedação, Analgesia e Bloqueio Neuromuscular em Terapia Intensiva. Clínicas Brasileiras de Medicina Intensiva, Sedação, Analgesia e Bloqueio Neuromuscular em UTI. 1997:241-255.

Amaral JLG, Issy AM, Conceição NA. . 1999.

Shafer A, Doze VA, White PF. Pharmacokinetic variability of midazolam infusions in critically Ill patients. Crit Care Med. 1990;18:1039-1041.

Pepperman ML. Double-blind study of the reversal of midazolam-induced sedation in the intensive care unit with flumazenil (Ro 15-1788): effect on weaning from ventilation. Anaesth Intens Care. 1990;18:38-44.

Geller E, Halpern P, Barzelal E. Midazolam and flumazenil for sedation in intensive care patients. Resuscitation. 1988;16:S31-S39.

Willats SM. Paralysis for ventilated patients?: Yes or no?. Intensive Care Med. 1985;11:2-4.

Peat SJ, Potter DR, Hunter JM. The prolonged use of atracurium in a patient with tetanus. Anaesthesia. 1988;43:962-963.

Pollard BJ, Harper NJM, Doran BRH. Use of continuous prolonged administration of atracurium in the ITU to a patient with myasthenia gravis. Br J Anaesth. 1989;62:95-97.

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