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Sedation and shivering management after cardiac arrest
Bram J Geller1, Carolina B Maciel2, Teresa L May3
1Department of Cardiovascular Medicine and Cardiovascular Critical Care Services, Maine Medical Center, Portland, ME, USA.
European Heart Journal. Acute Cardiovascular Care
|July 21, 2023
Summary
Managing sedation and shivering during targeted temperature management (TTM) after cardiac arrest requires careful consideration. This review outlines best practices for optimizing patient care and outcomes during TTM protocols.
Area of Science:
- Critical Care Medicine
- Neuroscience
- Pharmacology
Background:
- Effective sedation and shivering management are crucial for targeted temperature management (TTM) post-cardiac arrest.
- Limited high-quality evidence exists, necessitating extrapolation from general intensive care unit (ICU) data with caution.
Approach:
- Review of current literature and clinical best practices for sedation and shivering control in post-cardiac arrest patients.
- Consideration of unique physiological changes and treatment goals in this specific patient population.
Key Points:
- Sedation goals in post-cardiac arrest differ from general ICU patients, often including shivering suppression during TTM.
- Altered drug metabolism during TTM can impact clearance and neuroprognostication.
- Deep or prolonged sedation may lead to complications like delirium, infections, and delayed neurological assessment.
Conclusions:
- Optimizing sedation and shivering management is vital for improving outcomes in post-cardiac arrest patients undergoing TTM.
- Clinicians must balance the need for adequate sedation and shivering control with the risks of prolonged or excessive sedation.
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