General Critical Care

Analgesia and Sedation Use During Noninvasive Ventilation for Acute Respiratory Failure

Critical Care Medicine (lww.com)

This study examines the use of analgesia and sedation during noninvasive ventilation (NIV) for acute respiratory failure (ARF) across 1,017 U.S. hospitals. Among 433,357 patients, 26.7% received analgesia or sedation, with opioids (11.7%) and benzodiazepines (9.4%) being most common. Medication use was linked to higher odds of intubation (7.4%) or death (5.6%). Patients receiving any study medication had a 38% increased odds of intubation or mortality (aOR 1.38, 95% CI 1.35–1.40). The study highlights potential risks, especially with combinations like opioids and benzodiazepines, and calls for further research.

Green discoloration of urine secondary to propofol!

Thank you @Ibrahim Ameen

In a multi-center, double-blind randomized trial across eight Dutch ICUs, 132 critically ill adults with delirium were administered intravenous haloperidol or placebo, resulting in no significant difference in delirium- and coma-free days. The study, which was terminated early for futility, also found haloperidol might decrease the need for benzodiazepines and reduce agitation-related behaviors, although these secondary outcomes were not statistically conclusive.

Efficacy of haloperidol to decrease the burden of delirium in adult critically ill patients: the EuRIDICE randomized clinical trial | Critical Care | Full Text (biomedcentral.com)

Published June 1, 2022 in the Intensive Care Medicine: The use of dexmedetomidine compared to other sedatives, resulted in a lower risk of delirium, and a modest reduction in duration of mechanical ventilation and ICU stay, but increased the risks of bradycardia and hypotension in mechanically ventilated adults.