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REVIEW ARTICLE
Year : 2020  |  Volume : 33  |  Issue : 2  |  Page : 339-345

Analgesia and sedation for patients in the intensive care unit: a systematic review


1 Department of Anaesthesia, Intensive Care and Pain Management, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Anaesthesia, Intensive Care and Pain Management, Ministry of Health, Menoufia, Egypt

Correspondence Address:
Moaaz M Mohammed
Shebin El-Kom City, Menoufia Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_417_18

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Objective To review the importance of sedation and analgesia in the ICU. Data sources A systematic search of MEDLINE (PubMed, Medscape, ScienceDirect, EMF-Portal) and internet was conducted on all articles published from 1974 to 2016. Study selection English language reports on the importance of sedation and analgesia in the ICU. The initial search presented 157 articles, where 23 had inclusion criteria. Data extraction Articles not reporting on the importance of sedation and analgesia in the ICU in the title or abstract were not included. Five independent investigators extracted data on the methods. Data synthesis Comparisons were made by a structured review with the results tabulated. Seven studies about the importance of the role of sedation and analgesia in the ICU, eight about assessing the adequacy of sedation, and eight about the strategies for administering sedatives in the ICU. Findings Pain perception varies according to the various factors including personality, cultural background, surroundings, and fear. It has been associated with the detrimental effects on sleep, agitation, and stress response. Anxiety is also brought about by continuous noise within the ICU. Patients in the ICU may also suffer from insomnia caused by a loss of normal melatonin secretion. Newer sedation scales are reported to show improvements in validity and reliability. Propofol may be associated with a more rapid wake-up than benzodiazepines. Conclusion Sedation is an important component of the treatment of mechanically ventilated, critically ill patients. Directing treatment to specific and individualized goals will assure that the patient needs are met. The use of a spontaneous waking trial, followed, when possible, by a spontaneous breathing trial, should be implemented widely in the care of critically ill patients requiring mechanical ventilation.


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