Providing comfort and safety to critically ill patient in intensive care unit is the biggest concern of any health care provider. Sedative, opioids, and neuromuscular blocking agents (NMBAs) are commonly used with a goal of achieving comfort and maintaining safety in the critically ill patients. Sedation has become an important part of critical care practice in minimizing patient discomfort and agitation. However, sedation has its own adverse effects too. An observational study of Kollef and coworkers have shown that patients who received continuous infusion of sedatives had longer mechanical ventilation than compared to those who received no sedation. The triad of agitation consist of pain, anxiety and delirium. Pain, delirium and anxiety
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Pohlman and coworkers utilized deep sedation in their study of breath-staking during low tidal volume ventilation suggested that ventilation mode is not a good source to determinant of the patient’s sedation requirement. Administration of neuromuscular blockade may be required if asynchrony persists despite adjustment in ventilation mode. The importance and use of NMBAs in mechanically ventilated patients is common. Some of the advantages of NMBAs include reduced oxygen consumption, improved PaO2, prevention of respiratory movements, increased chest-wall compliance, reduced inflammatory-mediator release, reduced dynamic hyperinflation, prevention of patient-ventilator asynchrony (including auto-triggering), and facilitation and maintenance of lung recruitment. However, there are also disadvantages associated with the use of neuromuscular blockade agents which includes variable effect on PaO2, increased atelectasis, cephalad displacement of the diaphragm, inability to increase minute ventilation in response to need for increased carbon dioxide removal, and airway closure. Even though, NMBAs are very helpful in many cases, yet, it is suggested to use with cautions to avoid any issues associated with …show more content…
The proper use of sedation and NMBA should be determined by utilizing standard rating scales and unit-based guidelines. The triad of sedation includes pain, anxiety and delirium. Pain is the most common in patient and can be treat by multimodal. Whereas, anxiety and delirium if not treated on time may get worsen and demands of high attention if patient stay becomes longer in ICU. It is always recommended to use any drug with caution because high dose are accompanied with severe adverse
Pohlman and coworkers utilized deep sedation in their study of breath-staking during low tidal volume ventilation suggested that ventilation mode is not a good source to determinant of the patient’s sedation requirement. Administration of neuromuscular blockade may be required if asynchrony persists despite adjustment in ventilation mode. The importance and use of NMBAs in mechanically ventilated patients is common. Some of the advantages of NMBAs include reduced oxygen consumption, improved PaO2, prevention of respiratory movements, increased chest-wall compliance, reduced inflammatory-mediator release, reduced dynamic hyperinflation, prevention of patient-ventilator asynchrony (including auto-triggering), and facilitation and maintenance of lung recruitment. However, there are also disadvantages associated with the use of neuromuscular blockade agents which includes variable effect on PaO2, increased atelectasis, cephalad displacement of the diaphragm, inability to increase minute ventilation in response to need for increased carbon dioxide removal, and airway closure. Even though, NMBAs are very helpful in many cases, yet, it is suggested to use with cautions to avoid any issues associated with …show more content…
The proper use of sedation and NMBA should be determined by utilizing standard rating scales and unit-based guidelines. The triad of sedation includes pain, anxiety and delirium. Pain is the most common in patient and can be treat by multimodal. Whereas, anxiety and delirium if not treated on time may get worsen and demands of high attention if patient stay becomes longer in ICU. It is always recommended to use any drug with caution because high dose are accompanied with severe adverse