Département d'Anesthésie et de Réanimation, CHU Toulouse, Université Toulouse III Paul Sabatier, Faculté de Médecine Toulouse-Rangueil, EA 4564-MATN, Institut Louis Bugnard, Toulouse, France.
Eur J Anaesthesiol. 2012 Jun;29(6):280-5. doi: 10.1097/EJA.0b013e328352234d.
Pain and discomfort arising from the routine care of intubated patients in the ICU is managed by continuous infusion of narcotic and sedative drugs. There is benefit in keeping infusion rates low because lightening sedation improves clinical outcome, but this risks breakthrough pain. Management of this discomfort by bolus administration could permit lower background infusion rates, but the lowest effective bolus dose of sufentanil to achieve this is unknown.
The aim of this study was to determine the effective analgesic dose in 90% of intubated patients (ED90) in the ICU given bolus sufentanil. Pain was assessed using a Behavioural Pain Scale (BPS) requiring a score of 3-4 during moving to the lateral decubitus position.
Prospective, dose response study.
A 16-bed multidisciplinary ICU in a French university hospital. Study period was from January to June 2010.
Intubated and ventilated patients were eligible for the study once they had reached a BPS of 3 or 4 and Ramsay score of 3-5 within 48 h of admission to the ICU.
The analgesic efficacy of a sufentanil bolus was measured during successive lateral decubitus positioning over a 72-h study period, using the BPS scale. The dose was increased with each subsequent turn to lateral decubitus until a BPS score of 3-4 was obtained (dose escalation, starting at zero).
BPS, Ramsay score, heart rate and mean arterial pressure were collected before and during each procedure.
A total of 25 patients were enrolled over 6 months. The ED90 bolus for sufentanil was 0.15 μg kg, but 40% of the patients subsequently demonstrated increased BPS with this dose.
The effective dose in 90% was 0.15 μg kg during the first 5 days of sedation. There were no adverse effects. A pre-emptive sufentanil bolus can be used to treat anticipated pain in the ICU. Regular and frequent assessments of acute pain and sedation are essential for adjusting the dose, on a case-by-case basis. This strategy may help clinicians to keep background infusions of sedatives and narcotics as low as possible and may improve clinical outcome.
ClinicalTrials.gov NCT01356732.
在 ICU 中对插管患者进行常规护理引起的疼痛和不适通过持续输注麻醉性和镇静性药物来缓解。降低输注率是有益的，因为减轻镇静可改善临床结果，但这可能会导致突破性疼痛。通过推注管理这种不适可以允许较低的背景输注率，但达到这一目标的舒芬太尼的最低有效推注剂量尚不清楚。
本研究旨在确定 ICU 中接受舒芬太尼推注的插管患者中 90%有效镇痛剂量（ED90）。疼痛使用行为疼痛量表（BPS）进行评估，在侧卧位移动时需要达到 3-4 分的评分。
前瞻性、剂量反应研究。
法国一所大学医院的 16 床多学科 ICU。研究期间为 2010 年 1 月至 6 月。
一旦在 ICU 入住后 48 小时内达到 BPS 为 3 或 4 分和 Ramsay 评分 3-5，接受插管和通气的患者即可纳入研究。
在 72 小时的研究期间，通过 BPS 量表，在连续侧卧位定位期间测量舒芬太尼推注的镇痛效果。剂量在每次侧卧位后增加，直到获得 BPS 评分 3-4（剂量递增，从零开始）。
在每次操作之前和期间收集 BPS、Ramsay 评分、心率和平均动脉压。
在 6 个月期间共纳入 25 名患者。舒芬太尼的 ED90 推注剂量为 0.15μg/kg，但 40%的患者随后表现出该剂量的 BPS 增加。
在镇静的前 5 天，90%的有效剂量为 0.15μg/kg。没有不良反应。在 ICU 中，预防性舒芬太尼推注可以用于治疗预期的疼痛。定期和频繁评估急性疼痛和镇静对于根据具体情况调整剂量至关重要。这种策略可能有助于临床医生尽可能降低镇静和麻醉性药物的背景输注率，并可能改善临床结果。
ClinicalTrials.gov NCT01356732。
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