Sedation options for the morbidly obese intensive care unit patient: a concise survey and an agenda for development.

IF 2.3 Multidisciplinary Respiratory Medicine Pub Date : 2015-03-07 eCollection Date: 2015-01-01 DOI:10.1186/s40248-015-0007-2
Riku Aantaa, Peter Tonner, Giorgio Conti, Dan Longrois, Jean Mantz, Jan P Mulier
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引用次数: 11

Abstract

Background: We offer some perspectives and commentary on the sedation of obese patients in the intensive care unit (ICU).

Discussion: Sedation in morbidly obese patients should conform to the same broad principles now current in ICU practice. These include a general presumption against benzodiazepines as first-line agents. Opioids should be avoided in any situation where spontaneous breathing is required. Remifentanil is the preferred agent where continuous stable opioid levels using an infusion are required, because of its lack of context-sensitive accumulation. Volatile anaesthetics may be an option for the same reason but there are no substantial, controlled demonstrations of effectiveness/safety in short-term use in the ICU setting. Propofol is a valuable resource in the morbidly obese patients but the duration of continuous sedation should not exceed 6 days, in order to avoid propofol infusion syndrome. Alpha-2 agonists offer a range of theoretically positive features for the sedation of morbidly obese patients, but at present there is a lack of pharmacokinetic data and a critical mass of high-grade clinical data. Dexmedetomidine has the attraction of not causing respiratory depression or obstructive breathing during sedation and its sympatholytic effects should help deliver stable blood pressure and heart rate. Ketamine has a poor tolerability profile in adults so its use in the ICU context is largely confined to paediatrics.

Conclusion: None of the agents currently available is ideal for every situation encountered in the management of morbidly obese patients. This article identifies additional research needed to place sedation practice of obese patients on a more systematic footing.

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病态肥胖重症监护病房患者的镇静选择:一项简明调查和发展议程。
背景:我们就重症监护病房(ICU)肥胖患者的镇静治疗提供一些观点和评论。讨论:病态肥胖患者的镇静应符合目前ICU实践中相同的广泛原则。其中包括对苯二氮卓类药物作为一线药物的一般推定。在任何需要自主呼吸的情况下都应避免使用阿片类药物。瑞芬太尼是需要持续稳定阿片类药物输注的首选药物,因为它缺乏环境敏感性积累。出于同样的原因,挥发性麻醉剂可能是一种选择,但在ICU环境中短期使用的有效性/安全性没有实质性的、可控的证明。异丙酚是病态肥胖患者的宝贵资源,但持续镇静时间不应超过6天,以避免异丙酚输注综合征。α -2激动剂为病态肥胖患者的镇静提供了一系列理论上的积极特征,但目前缺乏药代动力学数据和大量高质量的临床数据。右美托咪定在镇静期间不会引起呼吸抑制或呼吸障碍,其交感神经溶解作用有助于稳定血压和心率。氯胺酮在成人中的耐受性较差,因此其在ICU中的使用主要局限于儿科。结论:目前没有一种药物对病态肥胖患者的治疗是理想的。这篇文章指出,需要进行更多的研究,将肥胖患者的镇静实践置于更系统的基础上。
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来源期刊
Multidisciplinary Respiratory Medicine
Multidisciplinary Respiratory Medicine Medicine-Pulmonary and Respiratory Medicine
自引率
0.00%
发文量
23
期刊介绍: Multidisciplinary Respiratory Medicine is the official journal of the Italian Respiratory Society - Società Italiana di Pneumologia (IRS/SIP). The journal publishes on all aspects of respiratory medicine and related fields, with a particular focus on interdisciplinary and translational research. The interdisciplinary nature of the journal provides a unique opportunity for researchers, clinicians and healthcare professionals across specialties to collaborate and exchange information. The journal provides a high visibility platform for the publication and dissemination of top quality original scientific articles, reviews and important position papers documenting clinical and experimental advances.
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