TY - JOUR
T1 - Editor’s Choice-The cardiovascular implications of sedatives in the cardiac intensive care unit
AU - Zakaria, Sammy
AU - Kwong, Helaine J.
AU - Sevransky, Jonathan E.
AU - Williams, Marlene S.
AU - Chandra-Strobos, Nisha
N1 - Publisher Copyright:
© The European Society of Cardiology 2017.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Patients admitted to the cardiac intensive care unit frequently develop multi-organ system dysfunction associated with their cardiac disease. In many cases, invasive mechanical ventilation is required, which often necessitates sedation for patient-ventilator synchrony, reduction of work of breathing, and patient comfort. In this paper, we describe the use of common sedatives available in the endotracheally intubated critically ill patient and emphasize the clinical and cardiovascular effects. We review γ-aminobutyric acid agonists such as etomidate, benzodiazepines, and propofol, the centrally acting α2-agonist dexmedetomidine, and the N-methyl-D-aspartate receptor antagonist ketamine. Additionally, we outline the use of opioids and their role in potentiating other sedatives. We note that some sedatives are associated with increased delirium rates, and emphasize that judicious strategies minimizing sedative use are associated with decreases in morbidity and mortality. We also discuss standardized sedation assessment scales and highlight the importance of sedation weaning. Finally, we offer recommendations for sedation use during therapeutic hypothermia, and discuss the use of adjuvant neuromuscular blocking agents.
AB - Patients admitted to the cardiac intensive care unit frequently develop multi-organ system dysfunction associated with their cardiac disease. In many cases, invasive mechanical ventilation is required, which often necessitates sedation for patient-ventilator synchrony, reduction of work of breathing, and patient comfort. In this paper, we describe the use of common sedatives available in the endotracheally intubated critically ill patient and emphasize the clinical and cardiovascular effects. We review γ-aminobutyric acid agonists such as etomidate, benzodiazepines, and propofol, the centrally acting α2-agonist dexmedetomidine, and the N-methyl-D-aspartate receptor antagonist ketamine. Additionally, we outline the use of opioids and their role in potentiating other sedatives. We note that some sedatives are associated with increased delirium rates, and emphasize that judicious strategies minimizing sedative use are associated with decreases in morbidity and mortality. We also discuss standardized sedation assessment scales and highlight the importance of sedation weaning. Finally, we offer recommendations for sedation use during therapeutic hypothermia, and discuss the use of adjuvant neuromuscular blocking agents.
KW - Sedation
KW - benzodiazepines
KW - cardiac critical care
KW - dexmedetomidine
KW - intensive care unit
KW - ketamine
KW - opioids
KW - propofol
KW - sedation assessment
UR - http://www.scopus.com/inward/record.url?scp=85055002226&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055002226&partnerID=8YFLogxK
U2 - 10.1177/2048872617695231
DO - 10.1177/2048872617695231
M3 - Review article
C2 - 29064259
AN - SCOPUS:85055002226
SN - 2048-8726
VL - 7
SP - 671
EP - 683
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
IS - 7
ER -