Efficacy and safety of analgesia based sedation of mechanical ventilated patients

The consequences of inadequate sedation and analgesia with patients undergoing mechanical ventilation can be substantial. Therapeutic sedation has inherent risks, particularly when excessive or prolonged. The pharmacodynamic effects of traditionally used sedative and opioid drugs are unpredictable and often prolonged in the critically ill patients for various reasons. The pharmacokinetics is altered with different volumes of distribution and elimination half-times. The opioid part of a sedation regime is kept to a minimum to protect against opioid accumulation and an unpredictable recovery/weaning from mechanical ventilation. The study compared the safety and efficacy of an analgesia based sedation regime using remifentanil with a conventional hypnotic-based sedation regime in critically ill patients requiring mechanical ventilation for up to 72 hours in comparison with a standard sedative regime of propofol and morphine. The efficiency of remifentanil was assessed by the primary endpoint of time from starting the study drug until extubation time. The safety profile of remifentanil was assessed by monitoring hemodynamic parameters and recording adverse events throughout the study period. Analgesia-based sedation with remifentanil was well tolerated. No significant difference in mechanical ventilation duration of critically ill patients and total mortality rate is noticed, but it is decided that it definitely improves the healing process in comparison to standard hypnotic-based sedation regimes in Intensive care unit (ICU) patients requiring ventilation for up to 72 hours.