0
Editorials |

Sedation and Neuromuscular Blockade in the ICU

Charles Weissman, MD
Author and Funding Information

Affiliations: Jerusalem, Israel
 ,  Dr. Weissman is Professor and Chair, Department of Anesthesiology and Critical Care Medicine, Hebrew University, Hadassah School of Medicine and Hadassah-Hebrew University Medical Center.

Correspondence to: Charles Weissman, MD, Department of Anesthesiology and Critical Care Medicine, Hadassah-University Hospital, Kiryat Hadassah, PO Box 12000, Jerusalem, Israel 91120; e-mail: Charles@hadassah.org.il



Chest. 2005;128(2):477-479. doi:10.1378/chest.128.2.477
Text Size: A A A
Published online

Extract

Among the key innovations of critical care medicine is treatment directed by continuously measured objective physiologic data. A prime example is the dosing of vasopressors using continuous measurements of systemic arterial pressure acquired from an indwelling arterial catheter. Similarly, the settings of mechanical ventilators are based on pressure and volume measurements of airway gases and arterial blood gas analysis. However, not all of the care provided in ICUs is so carefully monitored and titrated. This is especially true concerning sedation and analgesia, which are widely used in ICUs, as reported in this issue of CHEST (see page 496), by Arroliga and colleagues. These investigators analyzed data from a prospective, multicenter, international cohort of 5,183 adult ICU patients who received mechanical ventilation for > 12 h in 361 ICUs. Sixty-eight percent of these patients received sedation while being mechanically ventilated, while 13% also received a neuromuscular blocker for at least 1 day. The latter patients had a 50% mortality rate. The sedated patients had longer durations of mechanical ventilation, weaning time, and ICU stays than nonsedated patients. These results are not unexpected since patients receiving sedation and neuromuscular blockade tend to be the most severely ill. However, there is always the lingering question as to whether sedation, analgesia, and administration of neuromuscular blockers contribute to the morbidity and mortality of such patients or are only indications of severe illness.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543