The sedative effects of fentanyl on ventilated patients in intensive care unit_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Xifeng , KANG Yan ,  LIU Jin

Department of Anesthesiology and Critical Care Medicine，West China Hospital，Sichuan University.Chengdu，Sichuan，610041，ChinaCorresponding author：LIU Jin，E-mail：gege_0011@hotmail.com;

Corresponding author：

LIU Jin, Email: gege_0011@hotmail.com

Keywords：

Mechanical ventilation; Sedation; Midazolam; Fentanyl

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Objective To evaluate the sedative effects of fentanyl on ventilated patients in intensive care unit (ICU ).Methods Thirty orotracheal intubated and mechanical ventilated medical patients in ICU were randomly divided into two groups，ie.Midazolam group (group M) and midazolam combined with fentanyl group with a proportion of 100∶1 (group M+F) The sedatives were continuously intravenously infused to achieve a target motor activity assessment scale (MAAS) of 3 and ventilator synchrony score of adaptation to the intensive care environment (ATICE) ≥3 after loading dose of midazolam.The sedation level was evaluated and the infusion rate was adjusted to maintain the target sedation goal every 2 h and the hemodynamic，respiratory and sedative parameters were recorded simultaneously.The oxygenation index were measured at 12 and 24 h.The infusion were ceased after 24 h,then the sedative degree was assessed every 30 min until MAAS ≥3 and the recover time were recorded.Results There were no significant differences in blood pressure，oxygenation index and adjustive frequency of drugs between the two groups (all P gt;0.05).The heart rate，respiratory rate and airway pressure in group M+F decreased significantly than those in Group M (P lt;0.05).The amount of midazolam used and cost of sedatives were lower than those in group M (P lt;0.05).Satisfactory degree of sedation or ventilator synchrony and awakeness score of ATICE in group M+F were higher than those in group M.The recover time was shorter in groupM+F (P lt;0.05).Conclusion In medical ventilated patients, fentanyl improves the sedative effect of midazolam and reduces the dose of midazolam,hence,reduce the total cost of sedatives.

Citation： WANG Xifeng,KANG Yan,LIU Jin. The sedative effects of fentanyl on ventilated patients in intensive care unit. Chinese Journal of Respiratory and Critical Care Medicine, 2007, 6(1): 33-38. doi: Copy

1.	Burchardi H.Aims of sedation/analgesia.Minerva-Anestesiol，2004，70：137-143.
2.	Swaiss IG，Badran I.Discomfort，awareness and recall in the intensive care--still a problem? Middle East J Anesthesiol，2004，17：951-958.
3.	Mallick A，Smith SN，Bodenham AR.Local anaesthesia to the airway reduces sedation requirements in patients undergoing artificial ventilation.Br J Anaesth，1996，77：731-734.
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8.	Schlunder C，Houben F，Hartwig S，et al.Analgesia and sedation in neonatal-pediatric intensive care.Klin Wochenschr，1991，69 Suppl 26：95-99.
9.	Karabinis A，Mandragos K，Stergiopoulos S，et al.Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries：a randomised，controlled trial.Crit Care，2004，8：268-280.
10.	Watson BD，Kane-Gill SL.Sedation assessment in critically ill adults：2001-2004 update.Ann Pharmacother，2004，38：1898-1906.
11.	Gehlbach BK，Kress JP.Sedation in the intensive care unit.Curr Opin Crit Care，2002，8：290-298.
12.	孔灵菲，白晓昱，李振华，等.机械通气配合镇静麻醉和肌松剂抢救重症哮喘.中国呼吸与危重监护杂志，2002，1：43-44.
13.	De Jonghe B，Cook D，Griffith L，et al.Adaptation to the Intensive Care Environment (ATICE)：development and validation of a new sedation assessment instrument.Crit Care Med，2003，31：2344-2354.
14.	Muellejans B，Lopez A，Cross MH，et al.Remifentanil versus fentanyl for analgesia based sedation to provide patient comfort in the intensive care unit：a randomized，double-blind controlled trial.Crit Care，2004，8：R1-R11.
15.	Crocker C.Nurse led weaning from ventilatory and respiratory support.Intensive Crit Care Nurs，2002，18：272-279.
16.	Ely EW.The utility of weaning protocols to expedite liberation from mechanical ventilation.Respir Care Clin N Am，2000，6：303-319.
17.	Ely EW，Meade MO，Haponik EF，et al.Mechanical ventilator weaning protocols driven by nonphysician health-care professionals：evidence-based clinical practice guidelines.Chest，2001，120：454S-463S.
18.	Jones C，Griffiths RD，Humphris G.Disturbed memory and amnesia related to intensive care.Memory，2000，8：79-94.
19.	Jones C，Griffiths RD，Humphris G，et al.Memory，delusions，and the development of acute posttraumatic stress disorder-related syndromes after intensive care.Crit Care Med，2001，29：573-580.
20.	Scragg P，Jones A，Fauvel N.Psychological problems following ICU treatment.Anaesthesia，2001，56：9-14.
21.	Aldemir M，Ozen S，Kara IH，et al.Predisposing factors for delirium in the surgical intensive care unit.Crit Care，2001，5：265-270.
22.	van de Leur JP，van der Schans CP，Loef BG，et al.Discomfort and factual recollection in intensive care unit patients.Crit Care，2004，8：R467-R473.
23.	Brockmann C，Raasch W，Bastian C.Endocrine stress parameters during TIVA with remifentanil or sufentanil.Anasthesiol Intensivmed Notfallmed Schmerzther，2000，35：685-691.
24.	Mastronardi P，Cafiero T.Rational use of opioids.Minerva Anestesiol，2001，67：332-337.
25.	Breen D，Karabinis A，Malbrain M，et al.Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients：a randomised trial.Crit Care，2005，9：R200-R210.

1. Burchardi H.Aims of sedation/analgesia.Minerva-Anestesiol，2004，70：137-143.
2. Swaiss IG，Badran I.Discomfort，awareness and recall in the intensive care--still a problem? Middle East J Anesthesiol，2004，17：951-958.
3. Mallick A，Smith SN，Bodenham AR.Local anaesthesia to the airway reduces sedation requirements in patients undergoing artificial ventilation.Br J Anaesth，1996，77：731-734.
4. Guinsburg R，Kopelman BI，Anand KJ，et al.Physiological，hormonal，and behavioral responses to a single fentanyl dose in intubated and ventilated preterm neonates.J Pediatr，1998，132：954-959.
5. Dyke MP，Kohan R，Evans S.Morphine increases synchronous ventilation in preterm infants.J Paediatr Child Health，1995，31：176-179.
6. Katz R，Kelly HW.Pharmacokinetics of continuous infusions of fentanyl in critically ill children.Crit Care Med，1993，21：995-1000.
7. Irazuzta J，Pascucci R，Perlman N，et al.Effects of fentanyl administration on respiratory system compliance in infants.Crit Care Med，1993，21：1001-1004.
8. Schlunder C，Houben F，Hartwig S，et al.Analgesia and sedation in neonatal-pediatric intensive care.Klin Wochenschr，1991，69 Suppl 26：95-99.
9. Karabinis A，Mandragos K，Stergiopoulos S，et al.Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries：a randomised，controlled trial.Crit Care，2004，8：268-280.
10. Watson BD，Kane-Gill SL.Sedation assessment in critically ill adults：2001-2004 update.Ann Pharmacother，2004，38：1898-1906.
11. Gehlbach BK，Kress JP.Sedation in the intensive care unit.Curr Opin Crit Care，2002，8：290-298.
12. 孔灵菲，白晓昱，李振华，等.机械通气配合镇静麻醉和肌松剂抢救重症哮喘.中国呼吸与危重监护杂志，2002，1：43-44.
13. De Jonghe B，Cook D，Griffith L，et al.Adaptation to the Intensive Care Environment (ATICE)：development and validation of a new sedation assessment instrument.Crit Care Med，2003，31：2344-2354.
14. Muellejans B，Lopez A，Cross MH，et al.Remifentanil versus fentanyl for analgesia based sedation to provide patient comfort in the intensive care unit：a randomized，double-blind controlled trial.Crit Care，2004，8：R1-R11.
15. Crocker C.Nurse led weaning from ventilatory and respiratory support.Intensive Crit Care Nurs，2002，18：272-279.
16. Ely EW.The utility of weaning protocols to expedite liberation from mechanical ventilation.Respir Care Clin N Am，2000，6：303-319.
17. Ely EW，Meade MO，Haponik EF，et al.Mechanical ventilator weaning protocols driven by nonphysician health-care professionals：evidence-based clinical practice guidelines.Chest，2001，120：454S-463S.
18. Jones C，Griffiths RD，Humphris G.Disturbed memory and amnesia related to intensive care.Memory，2000，8：79-94.
19. Jones C，Griffiths RD，Humphris G，et al.Memory，delusions，and the development of acute posttraumatic stress disorder-related syndromes after intensive care.Crit Care Med，2001，29：573-580.
20. Scragg P，Jones A，Fauvel N.Psychological problems following ICU treatment.Anaesthesia，2001，56：9-14.
21. Aldemir M，Ozen S，Kara IH，et al.Predisposing factors for delirium in the surgical intensive care unit.Crit Care，2001，5：265-270.
22. van de Leur JP，van der Schans CP，Loef BG，et al.Discomfort and factual recollection in intensive care unit patients.Crit Care，2004，8：R467-R473.
23. Brockmann C，Raasch W，Bastian C.Endocrine stress parameters during TIVA with remifentanil or sufentanil.Anasthesiol Intensivmed Notfallmed Schmerzther，2000，35：685-691.
24. Mastronardi P，Cafiero T.Rational use of opioids.Minerva Anestesiol，2001，67：332-337.
25. Breen D，Karabinis A，Malbrain M，et al.Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnotic-based sedation for up to 10 days in intensive care unit patients：a randomised trial.Crit Care，2005，9：R200-R210.

Chinese Journal of Respiratory and Critical Care Medicine

The sedative effects of fentanyl on ventilated patients in intensive care unit

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