Department of Pharmacy, Maine Medical Center, Portland, Maine.
Tufts University School of Medicine, Boston, Massachusetts.
Pharmacotherapy. 2017 Oct;37(10):1309-1321. doi: 10.1002/phar.2017.
Provision of adequate sedation is a fundamental part of caring for critically ill patients. Propofol, dexmedetomidine, and benzodiazepines are the most commonly administered sedative medications for adult patients in the intensive care unit (ICU). These agents are limited by adverse effects, need for a monitored environment for safe administration, and lack of universal effectiveness. Increased interest has recently been expressed about repurposing older pharmacologic agents for patient comfort in the ICU. Valproate, enteral clonidine, and phenobarbital are three agents with increasing evidence supporting their use. Potential benefits associated with their utilization are cost minimization and safe administration after transition out of the ICU. This literature review describes the historical context, pharmacologic characteristics, supportive data, and practical considerations associated with the administration of these agents for comfort in critically ill adult patients.
为危重症患者提供充分的镇静是护理的基本组成部分。丙泊酚、右美托咪定和苯二氮䓬类药物是重症监护病房（ICU）中成人患者最常使用的镇静药物。这些药物受不良反应、需要安全给药的监测环境以及缺乏普遍有效性的限制。最近，人们对重新利用旧的药物来提高 ICU 患者的舒适度表现出了越来越大的兴趣。丙戊酸钠、肠内可乐定和苯巴比妥是三种越来越多证据支持其使用的药物。与它们的使用相关的潜在益处是成本最小化和 ICU 转出后的安全给药。本文综述描述了这些药物用于危重症成年患者的舒适度的历史背景、药理学特征、支持数据和实际考虑因素。
