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The Stress Response of Critical Illness: Which Is the Role of Sedation?

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Critical Care Sedation

Abstract

Trauma, surgery, and infection represent a common source of stress in critically ill patients admitted in intensive care units (ICUs). Although the consequences of stress response in critical illness are still debated and not well understood, many neural and hormonal responses have been recognized to activate homeostatic mechanisms aimed at favoring survival and healing. These responses develop toward three different phases: the first immediate and short (24 h) phase, termed ebb, is directed to immediate survival; the second longer phase (6–7 days), termed flow, is characterized by an increase in total body oxygen consumption and carbon dioxide production with hypermetabolism; the third phase, termed chronic, may last some months and identifies the post-stress period of critical illness. Although the effects of sedatives (analgesics and hypnotics) on tissue metabolic demand of critically ill patient remain difficult to be adequately defined, these drugs commonly delivered in intensive care units actually influence the stress response by decreasing neurohumoral reactions, involving the sympathetic system, and affecting the inflammatory mechanisms. After the neuroendocrine activation, uncontrolled metabolic reactions, characterized by catabolism and the resistance to anabolic signals as insulin, develop. Secondary negative effects (infections, muscle atrophy and weakness, respiratory insufficiency, delayed wound healing) can occur as direct consequences of metabolic phenomena that are clearly difficult to monitor. Finally, sedatives administered to control stress response clearly have detrimental effects (hemodynamic alterations, immunosuppression, delirium) that should be carefully evaluated in the context of a balance between benefits and damages.

“Today there is a greater and growing awareness of the need to understand the disturbed metabolism and homeostatic mechanisms which come into play when man is injured, whether by accident or surgery, and how these reactions may be assisted in relation to improving the patient’s condition.”

D. P. Cuthbertson, 1975

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Authors and Affiliations

  1. Department of Anesthesia and Critical Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    A. Raffaele De Gaudio, Matteo Bonifazi & Stefano Romagnoli

  2. Department of Health Sciences, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    A. Raffaele De Gaudio, Matteo Bonifazi & Stefano Romagnoli

Authors
  1. A. Raffaele De Gaudio
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  2. Matteo Bonifazi
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  3. Stefano Romagnoli
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Correspondence to A. Raffaele De Gaudio .

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Editors and Affiliations

  1. Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy

    Angelo Raffaele De Gaudio

  2. Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy

    Stefano Romagnoli

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De Gaudio, A.R., Bonifazi, M., Romagnoli, S. (2018). The Stress Response of Critical Illness: Which Is the Role of Sedation?. In: De Gaudio, A., Romagnoli, S. (eds) Critical Care Sedation. Springer, Cham. https://doi.org/10.1007/978-3-319-59312-8_2

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  • DOI: https://doi.org/10.1007/978-3-319-59312-8_2

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-59312-8

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