Skip to main content
SpringerLink
Log in

Sevrage de la sédation en réanimation

  • Chapter
Book cover Analgésie et sédation en réanimation

Part of the book series: Le point sur ... ((POINT))

  • 531 Accesses

Resume

Les difficultés de sevrage de la sédation doivent être le plus souvent prévenues par une adaptation de la sédation aux besoins du patient, la diminution de la profondeur de la sédation chaque fois que cela est possible, voire son interruption temporaire. Cette attitude est difficile au quotidien et nécessite à la fois une information, une formation et une adhésion de l’ensemble du personnel soignant. Lorsque cela est réalisé, le sevrage de la sédation est une question qui ne se pose pratiquement plus. Mais certains patients ont besoin d’une sédation profonde pendant une durée parfois longue. Lorsque l’état clinique s’améliore, la réévaluation quotidienne de la pertinence de la sédation est une nécessité. Des syndromes de sevrage peuvent alors survenir. Les conséquences physiologiques liées au sevrage de la sédation sont encore mal connues, mais potentiellement délétères sur le système respiratoire, cardio-vasculaire ou sur le système nerveux central. Dans ce cas, il n’y a pas de schéma validé d’arrêt de la sédation, mais la titration en fonction d’un score clinique et le recours éventuel à des agents alpha2-agonistes pour limiter l’hyperactivité sympathique peuvent être recommandés.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Mantz J (2008) Sevrage de la sédation: modalités et conséquences. Ann Fr Anesth Reanim 27: 611–6

    CAS  PubMed  Google Scholar 

  2. Brook AD, Ahrens TS, Schaiff R et al. (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27: 2609–15

    Article  CAS  PubMed  Google Scholar 

  3. Kress J P, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342: 1471–7

    Article  CAS  PubMed  Google Scholar 

  4. Bruder N, Raynal M, Pellissier D et al. (1998) Influence of body temperature, with or without sedation, on energy expenditure in severe head-injured patients. Crit Care Med 26: 568–72

    Article  CAS  PubMed  Google Scholar 

  5. Frankenfield D, Wiles Cr, Bagley S, Siegel J (1994) Relationships between resting and total energy expenditure in injured and septic patients. Crit Care Med 22: 1796–804

    CAS  PubMed  Google Scholar 

  6. Bruder N, Lassegue D, Pelissier D et al. (1994) Energy expenditure and withdrawal of sedation in severe head-injured patients. Crit Care Med 22: 1114–9

    Article  CAS  PubMed  Google Scholar 

  7. Field S, Kelly SM, Macklem PT (1982) The oxygen cost of breathing in patients with cardiorespiratory disease. Am Rev Respir Dis 126: 9–13

    CAS  PubMed  Google Scholar 

  8. Busto U, Sellers EM, Naranjo CA et al. (1986) Withdrawal reaction after long-term therapeutic use of benzodiazepines. N Engl J Med 315: 854–9

    Article  CAS  PubMed  Google Scholar 

  9. Bruder N, Stordeur J (2001) Troubles du comportement et agitation en réanimation. In: Sfar éd. 43e congrès national d’anesthésie et de réanimation. Paris: Elsevier, 449–66

    Google Scholar 

  10. Cammarano WB, Pittet JF, Weitz S et al. (1998) Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients. Crit Care Med 26: 676–84

    Article  CAS  PubMed  Google Scholar 

  11. Ista E, Van Dijk M, Gamel C et al. (2008) Withdrawal symptoms in critically ill children after long-term administration of sedatives and/or analgesics: a first evaluation. Crit Care Med 36: 2427–32

    Article  CAS  PubMed  Google Scholar 

  12. Korak-Leiter M, Likar R, Oher M et al. (2005) Withdrawal following sufentanil/propofol and sufentanil/midazolam. Sedation in surgical ICU patients: correlation with central nervous parameters and endogenous opioids. Intensive Care Med 31: 380–7

    Article  PubMed  Google Scholar 

  13. Jacobi J, Fraser GL, Coursin DB et al. (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30: 119–41

    Article  PubMed  Google Scholar 

  14. Katz R, Kelly H, Hsi A (1994) Prospective study on the occurence of withdrawal in critically ill children who receive fentanyl by continuous infusion. Critical Care Medicine 22: 763–7

    Article  CAS  PubMed  Google Scholar 

  15. Fonsmark L, Rasmussen YH, Carl P (1999) Occurrence of withdrawal in critically ill sedated children. Crit Care Med 27: 196–9

    Article  CAS  PubMed  Google Scholar 

  16. Ista E, Van Dijk M, Gamel C et al. (2007) Withdrawal symptoms in children after longterm administration of sedatives and/or analgesics: a literature review. “Assessment remains troublesome”. Intensive Care Med 33: 1396–406

    Article  CAS  PubMed  Google Scholar 

  17. Delvaux B, Ryckwaert Y, Van Boven M et al. (2005) Remifentanil in the intensive care unit: tolerance and acute withdrawal syndrome after prolonged sedation. Anesthesiology 102: 1281–2

    Article  PubMed  Google Scholar 

  18. Breen D, Karabinis A, Malbrain M et al. (2005) Decreased duration of mechanical ventilation when comparing analgesia-based sedation using remifentanil with standard hypnoticbased sedation for up to 10 days in intensive care unit patients: a randomised trial [ISRCTN47583497]. Crit Care 9: R200–10

    Article  PubMed  Google Scholar 

  19. Park G, Lane M, Rogers S, Bassett P (2007) A comparison of hypnotic and analgesic based sedation in a general intensive care unit. Br J Anaesth 98: 76–82

    Article  CAS  PubMed  Google Scholar 

  20. Shafer A (1998) Complications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens. Critical Care Medicine 26: 947–56

    Article  CAS  PubMed  Google Scholar 

  21. De Jonghe B, Appere-De-Vecchi C, Outin H (2008) Prise en charge du patient sédaté. Ann Fr Anesth Reanim 27: 641–54

    PubMed  Google Scholar 

  22. Treggiari MM, Romand JA, Yanez ND et al. (2009) Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med 37: 2527–34

    Article  PubMed  Google Scholar 

  23. Kress JP, Gehlbach B, Lacy M et al. (2003) The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med 168: 1457–61

    Article  PubMed  Google Scholar 

  24. Girard TD, Kress JP, Fuchs BD et al. (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371: 126–34

    Article  PubMed  Google Scholar 

  25. Masica AL, Girard TD, Wilkinson GR et al. (2007) Clinical sedation scores as indicators of sedative and analgesic drug exposure in intensive care unit patients. Am J Geriatr Pharmacother 5: 218–31

    Article  CAS  PubMed  Google Scholar 

  26. Moss M, Burnham EL (2006) Alcohol abuse in the critically ill patient. Lancet 368: 2231–42

    Article  PubMed  Google Scholar 

  27. Spies CD, Rommelspacher H (1999) Alcohol withdrawal in the surgical patient: prevention and treatment. Anesth Analg 88: 946–54

    Article  CAS  PubMed  Google Scholar 

  28. Sullivan JT, Sykora K, Schneiderman J et al. (1989) Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict 84: 1353–7

    Article  CAS  PubMed  Google Scholar 

  29. Gold JA, Rimal B, Nolan A, Nelson LS (2007) A strategy of escalating doses of benzodiazepines and phenobarbital administration reduces the need for mechanical ventilation in delirium tremens. Crit Care Med 35: 724–30

    Article  CAS  PubMed  Google Scholar 

  30. de Wit M, Gennings C, Zilberberg M et al. (2008) Drug withdrawal, cocaine and sedative use disorders increase the need for mechanical ventilation in medical patients. Addiction 103: 1500–8

    Article  PubMed  Google Scholar 

  31. Mayer SA, Chong JY, Ridgway E et al. (2001) Delirium from nicotine withdrawal in neuroICU patients. Neurology 57: 551–3

    CAS  PubMed  Google Scholar 

  32. Tran-Van D, Herve Y, Labadie P et al. (2004) (Restlessness in intensive care unit: think to the nicotinic withdrawal syndrome]. Ann Fr Anesth Reanim 23: 604–6

    CAS  PubMed  Google Scholar 

  33. Lee AH, Afessa B (2007) The association of nicotine replacement therapy with mortality in a medical intensive care unit. Crit Care Med 35: 1517–21

    Article  CAS  PubMed  Google Scholar 

  34. Paciullo CA, Short MR, Steinke DT, Jennings HR (2009) Impact of nicotine replacement therapy on postoperative mortality following coronary artery bypass graft surgery. Ann Pharmacother 43: 1197–202

    Article  CAS  PubMed  Google Scholar 

  35. Anand KJ, Ingraham J. Pediatric (1996) Tolerance, dependence, and strategies for compassionate withdrawal of analgesics and anxiolytics in the pediatric ICU. Critical Care Nurse 16: 87–93

    CAS  PubMed  Google Scholar 

  36. Honey BL, Benefield RJ, Miller JL, Johnson PN (2009) Alpha2-receptor agonists for treatment and prevention of iatrogenic opioid abstinence syndrome in critically ill patients. Ann Pharmacother 43: 1506–11

    Article  CAS  PubMed  Google Scholar 

  37. Liatsi D, Tsapas B, Pampori S et al. (2009) Respiratory, metabolic and hemodynamic effects of clonidine in ventilated patients presenting with withdrawal syndrome. Intensive Care Med 35: 275–81

    Article  CAS  PubMed  Google Scholar 

  38. Baddigam K, Russo P, Russo J, Tobias JD (2005) Dexmedetomidine in the treatment of withdrawal syndromes in cardiothoracic surgery patients. J Intensive Care Med 20: 118–23

    Article  PubMed  Google Scholar 

  39. Pandharipande PP, Pun BT, Herr DL et al. (2007) Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. Jama 298: 2644–53

    Article  CAS  PubMed  Google Scholar 

  40. Riker RR, Shehabi Y, Bokesch PM et al. (2009) Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. Jama 301: 489–99.

    Article  CAS  PubMed  Google Scholar 

Download references

Authors
  1. N. Bruder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Velly
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag France, Paris

About this chapter

Cite this chapter

Bruder, N., Velly, L. (2010). Sevrage de la sédation en réanimation. In: Analgésie et sédation en réanimation. Le point sur .... Springer, Paris. https://doi.org/10.1007/978-2-287-99029-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-2-287-99029-8_7

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-287-99028-1

  • Online ISBN: 978-2-287-99029-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation