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[The effects of long-term sedation on intestinal function]
1Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen.
Der Anaesthesist
|December 1, 1995
Summary
Critically ill patients on mechanical ventilation experienced fewer gastrointestinal motility issues when treated with piritramide or ketamine for analgesia, compared to fentanyl-based regimens. Midazolam was the preferred sedative, with propofol as an alternative, improving enteral feeding tolerance.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Gastroenterology
Context:
- Maintaining gastrointestinal integrity and function is crucial for critically ill patients, impacting nutritional support and overall recovery.
- Long-term sedation with certain drugs can disrupt gastrointestinal motility, posing challenges in managing critically ill patients.
- This study investigates the impact of various analgesic and sedative combinations on intestinal function in mechanically ventilated patients.
Purpose:
- To compare the effects of different analgesic and sedative combinations on gastrointestinal function in mechanically ventilated, critically ill patients.
- To identify optimal drug regimens that preserve intestinal motility and facilitate enteral nutrition in this patient population.
Summary:
- A retrospective analysis of 190 mechanically ventilated patients compared 11 analgesic/sedative combinations.
- Piritramide and ketamine-based analgesia, particularly with midazolam or propofol for sedation, showed better gastrointestinal tolerance and facilitated enteral feeding compared to fentanyl-based regimens.
- High-dose barbiturates and short-acting opioids were associated with increased gastrointestinal motility disorders.
Impact:
- Suggests ketamine as a preferred analgesic, combined with propofol, for critically ill patients with elevated intracranial pressure requiring deep sedation.
- Recommends piritramide or ketamine for analgesia and midazolam (with potential propofol substitution) for sedation to improve gastrointestinal tolerance.
- Highlights the need for careful drug selection to mitigate gastrointestinal side effects in long-term sedation protocols for critically ill patients.