To compare effects between entropy index and bispectral index on monitoring the depth of sedation induced by Dexmedetomidine combined with Midazolam for patients requiring long-term sedation in ICU.

65 patients sedated over 3 days in ICU from September 2013 to September 2015 were enrolled. The patients were randomly divided into two groups according to the sigle blind random number table methed. Group A (n=32): entropy group; Group B (n=33): BIS group. The target of RASS score is between -1 to 0 for both group, while the entropy index target in Group A is RE 65-80, SE 60-75, and BIS target in group B is from 60 to 80. During investigation, heart rate, respiratory rate, mean arterial pressure, and sedation satisfaction were monitored continuously. The time to achieve the desired sedation level and the dosage of sedatives in the first three days were recorded. Meanwhile, the incidence of adverse reactions was monitored respectively.

It taked less time to achieve the desired sedation level in Group A than that in Group B [(3.78±1.38) h vs (5.78±2.17) h, P=0.0047]. Group A had more effective sedation [(78.2±15.4)% vs (56.7±11.7)%, P=0.0034], less adverse reactions and lower dosage of sedatives than those in Group B.

Entropy index can be applied to monitor the depth of sedation in patients requiring long-term sedation, and reach sedation target in a shorter time, reduce the dosage of sedatives and adverse reactions as well.

Remimazolam is a new type of ultra short acting benzodiazepine. It has an organ-independent metabolism resembling remifentanil and also acts on GABA receptors. It has a fast onset of action, rapid recovery, less impact on liver and kidney function and stable hemodynamics, which pharmacological effects can be quickly reversed by flumazenil. These characteristics make remazolam an ideal sedative theoretically. This article mainly reviews progress in Remimazolam's mechanism of action, pharmacokinetics, effects on organ function and clinical application, providing theoretical basis for clinical application.

To investigate the effect of early goal-oriented sedation strategy on gastrointestinal function in sepsis patients with different sedatives.

A randomized controlled study was conducted on patients with sepsis who were admitted to ICU of Zhuji Hospital of Traditional Chinese Medicine consecutively from January 2017 to February 2019. Sepsis patients were randomly divided into three groups: Dex group (n=31), Mid group (n=30) and Pro group (n=32). All three groups of patients adopted early goal-directed sedation (EGDS) based on the sufficient analgesia of butorphanol tartrate. Dex group was sedated with Dexmedetomidine, Mid group with Midazolam, Pro group with Propofol. Gastrointestinal indexes (DAO, IFABP and AGI grading) at day 1 (T1), day 3 (T3) and day 7 (T7) were recorded in the three groups. Average daily dose of analgesics, daily costs of sedation and analgesia during hospitalization, mechanical ventilation time, length of ICU stay, vasoactive drug usage, and delirium incidence were also recorded.

(1) gastrointestinal injury indexes: Dex group was significantly lower than Mid group and Pro group, and the differences in the interaction between the indexes, time points and between groups were statistically significant (P<0.05). There was no significant difference between the two groups (P>0.05). (2) AGI grading: Dex group was significantly lower than Mid group and Pro group, and the difference was statistically significant (P<0.05). (3) Average daily dose of analgesics, the average daily cost of sedation and analgesia, mechanical ventilation time, delirium incidence and 28-day mortality in Dex group were significantly reduced compared with Mid group and Pro group, and the differences were statistically significant (P<0.05). The utilization rates of Atropine and Isopropyl were significantly higher in the Dex group than in the Mid group and the Pro group (P<0.05). There was no significant difference in Norepinephrine usage (P>0.05).

The sedative and analgesic regimen of Dexmedetomidine combined with Butorphanol tartrate can improve the gastrointestinal function of patients with acute gastrointestinal injury caused by sepsis, reduce AGI grading, reduce mechanical ventilation time and reduce the incidence of delirium.

Pain and anxiety cause severe psychological stress and badly affect the outcome in intensive care unit (ICU) patients. Appropriate analgesia and sedation can meliorate pain and discomfort, reduce the risk of delirium and achieve the goal of organ protection. We must follow the sequence of assessment, analgesia and sedation. We also need to pay attention to non-pharmacologic interventions during analgesia and sedation. Setting up a complete and concise protocol can improve analgesia and sedation.

To observe the analgesic effect of Butorphanol combined with Dexmedetomidine in patients with traumatic brain injury (TBI), providing evidence for clinical treatment of TBI.

60 Patients with TBI admitted to the EICU between January 2018 and May 2018 were included and divided into two groups, the Butorphanol group (30 cases) and the Fentanyl group (30 cases), with a random number table. Patients in the Butorphanol group were treated with Butorphanol plus Dexmedetomidine and those in the Fentanyl group were treated with Fentanyl plus Dexmedetomidine for analgesia and sedation. Clinical indicators including APACHEⅡand GCS scores were recorded and comparatively analyzed for the two groups.

After treatment, the heart rate, respiration frequency, pain scores and the rate of nutrient retention of the patients in the Butorphanol group were lower than those of the Fentanyl group [(85.51±9.41) times/min vs (114.63±12.23) times/min, (23.41±3.92) times/min vs (33.87±5.12) times/min, (0.91±0.34) scores vs (2.11±0.39) scores, 10.0% vs 36.7%, all P<0.05], and the oxygen pressure was higher than that of the Fentanyl group [(96.21±10.51) mmHg vs (74.18±8.54) mmHg, P<0. 05]. No significant differences in other indicators were observed between the two groups.

Butorphanol combined with Dexmedetomidine is effective in patients with TBI in ICU with favorable analgesic effect and few complications.

To explore the sedation effect and safety of Dexmedetomidine in patients with moderate craniocerebral trauma.

62 cases of craniocerebral trauma in our department from May 2015 to June 2018 were selected as the research objects. They were randomly divided into the observation group and the control group after obtaining informed consent from either the patient or an approved surrogate. Patients in observation group were treated with Dexmedetomidine and the other group with diazepam. We compared the sedation and adverse effect of the two groups before sedation and 10 min, 30 min, 60 min and 120 min after sedation.

After the sedation with Dexmedetomidine in the observation group, the pulse oxygen saturation (SpO₂) of patients was significantly higher than before, while 60 and 120 min after sedation SpO₂ of patients in the control group was remarkably higher than before (P<0.05). The respiratory rate (RR) of patient in the control group was significantly lower than that in the observation group 10 min and 30 min after sedation [(30.01±4.26) times/min vs. (25.13±3.94) times/min, (27.94±3.35) times/min vs. (23.09±4.26) times/min, all P<0.05]. The onset time (OT) and wakeup time (WT) of the observation group after drug withdrawal were significantly shorter than OT and WT of the control group [(68.34±7.01) s vs. (285.48±9.59) s, (6.53±1.76) min vs. (28.71±2.37) min, P<0.05]. The rate of adverse reaction was 12.90% in the observation group and lower than 41.93% in the control group (P<0.05).

The sedation effect and safety of Dexmedetomidine is better than that of diazepam for the patients with moderate craniocerebral trauma.

Sedation has become one of the basic treatment in intensive care unit (ICU). Existing studies have demonstrated inhalation sedation might reduce the time to wake-up, time to follow the order, and has a protection for heart and brain. In this review, we summarized the advantages of using inhalation sedation in intensive care unit.

Analgesia and sedation are essential for critically ill patients. Now we change our target from patients′ comfort to organ protection. Analgesia and sedation have an important role in reducing respiratory distress, improving synchrony of mechanical ventilation, lowering transpulmonary pressure, reducing oxygen consumption, controlling intracranial pressure and metabolism, optimization of immune and inflammation. An organ protection directed sedation strategy will be more optimal in the future.

To evaluate the efficacy of sedation with dexmedetomidine and midazolam or propofol combined with fentanyl for sedation in critically ill patients undergoing non-invasive ventilation.

Six-four patients scheduled for non-invasive ventilation in ICU were received sedation, who was divided into two groups: group Dex (n=41, sedated signally by dexmedetomidine) and group non-Dex (n=23, sedated by midazolam or propofol combined with fentanyl). A loading of dexmedetomidine 1 μg/kg followed by infusion lose at 0.2-0.5 μg/(kg?h), a loading of midazolam 0.05 mg/kg followed by infusion lose at 0.02-0.10 mg/(kg?h) and a loading of propofol 3 mg/kg followed by infusion lose at 0.5-3.0 mg/(kg?h). At the same time of administration of the midazolam and propofol, a loading dose of fentanyl 1 μg/kg was given, followed by fentanyl infusion at 1-2 μg/(kg?h). Ramsay Sedation Score (RSS) was recorded at baseline and 1, 12, and 24 hours after the loading dose was administered. And the following parameters were measured at baseline and 1, 12 and 24 hours: heart rate, blood pressure, respiratory rate and arterial blood gases. During the course, delirium, tracheal intubation, over-sedation, hypotension, hypertension, bradycardia were observed and registered continuously.

In both of the two groups patients, expected sedative scores were obtained. At 1 hour after the administration of drugs, RSS levels of group Dex and non-Dex were (2.3±0.5) scores vs (2.3±0.4) scores, t=0.00, P=1.000; at 12 hour were (2.3±0.5) scores vs (3.3±0.8) scores, t=6.16, P<0.001; at 24 hour were (2.4±0.5) scores vs (3.2±0.6) scores, t=5.71, P<0.001. Compared with the group non-Dex, the duration of ICU hospitalization in the group Dex were markedly decreased [(4.9±2.0) d vs (6.8±3.2) d, P=0.026]. In both groups, there was no significant difference in PaO₂/FiO₂, respiratory rate and mean blood pressure at different time point. The incidents of tracheal intubation, over-sedation, hypotension, hypertension, and bradycardia were not significantly different between the two groups. At one hour after the administration of drugs, the heart rates of group Dex and non-Dex were (78.4±17.6) times vs (93.3±25.0) times, t=2.79, P=0.007; at 12 hour were (77.1±10.7) times vs (86.5±13.4) times, t=3.08, P=0.003; at 24 hour were (71.4±6.9) times vs (80.9±14.3) times, t=3.59, P=0.001. The rate of delirium was significantly lower in group Dex (7.3% vs 39.1%, P<0.05). In subgroup analysis, compared to the patients without acute heart failure, the incident rate of hypotension in the patients with acute heart failure was significantly higher (group Dex, 71.4% vs 8.8%, P=0.001, group non-Dex, 66.7% vs 11.8%, P=0.008).

Sedative effects of both dexmedetomidine and midazolam or propofol combined with fentanyl are satisfactory for patients undergoing NIV. However, it is necessary to enhance observation to prevent and control hypotension in patients with acute heart failure.

Critical illness, acute kidney injury and continuous renal replacement therapy are contributing factors to pharmacokinetics in critically ill patients. We should take the pharmacokinetic factors into account in the treatment of critically ill patients. The pharmacokinetic factors include drug absorption, tissuepenetration, drug metabolism and clearance. This article concluded the pharmacokineticsof the most commonly used analgesics and sedatives for critically ill patients and recommended the dosage adjustment during CRRT.

2002 published guidelines greatly promoted knowledge of intensive caring providers on analgesia and sedation for mechanically ventilated patients. Updated PAD guidelines in 2013 and eCASH concept in 2016 further suggested that adequate analgesia based light sedation-directed strategy be beneficial to outcomes. Accordingly, guidelines were valuable for standardizing as well as improving clinical practices extensively. However, it is the fact that compliance was significantly low to updated guidelines nowadays. Barriers happened in implementation of new approaches, such objective assessment of pain intensity, risk of light sedation on safety and right populations for eCASH as well, might be important one of the multiple impacting factors since knowledge of analgesia and sedation was widely promoted. Therefore, it is crucial for well implement of these new approaches to solve these problems.

The initial sedation practice in intensive care unit (ICU) which derived from anesthesia easily led to deep level or over sedation. However, with development of the research, deep sedation was gradually regarded to bring big harm to patients. So light sedation is recommended nowadays. However, the special target patients such as severe brain injury, persistent epilepsy, therapeutic low temperature and severe acute respiratory distress syndrome (ARDS) all need sedation in deep level. It is beneficial to treat most of critical ill patients with light sedation. To avoid unnecessary over sedation, strategies such as analgosedation, the protocolized sedation in goal of light level and early goal directed sedation are praised at present.

Post intensive care syndrome (PICS) describes the disability that remains in the survivors of critical illness after an intensive care unit (ICU) stay. This syndrome comprises of impairment in cognition, psychological health, and physical function in the ICU survivors, and may lead to reduced quality of life, causing a lot of suffering to these patients and their families. Recommendations have been made for preventing PICS in the 2013 PAD guidelines, in the ABCDE bundle and in the eCASH concept, all of which prioritise the management of pain, agitation and delirium in adult patients in ICU.

ICU patients are in a various of intense stress state due to their diseases and other factors. Analgesic and sedative treatments are routine used to control these adverse stress responses effectively. However, studies have shown that both over and lack of sedation can lead to many adverse outcomes, such as prolonged mechanical ventilation, ventilator-associated pneumonia (VAP), and increased delirium and mortality. Therefore, in addition to improved analgesic and sedative strategies, real-time and accurate assessment is important for analgesic and sedative management in ICU patients. Here, we review the characteristics of each analgesic and sedative assessments that widely used in clinic.

Analgesia and sedation are common clinical practices in intensive care unit. Approprite analgesia and sedation should be patient-oriented and disease-oriented. Understand the pharmacological characteristics of analgesic and sedative, individual light sedation on the basis of adequate analgesia to make the patient achieve the best condition. Opioids are considered the first-line drug class of choice to treat non-neuropathic pain in critically ill patients. Combine strategy can reduce total opioid dosage and avoid adverse effects. Benzodiazepines exposure is an independent risk factors for ICU delirium. Therefore, short-acting, easy-to-titrate agents such as propofol and dexmedetomidine were selected as the first line choice. Benzodiazepines should be reserved for specific indications, such as procedural sedation, seizures, alcohol and benzodiazepine withdrawal, apparent anxiety,agitation and deep sedation. Further research on how to rational application of analgesic and sedative is needed.

Delirium is an acute, non-specific cerebral impairment characterized by a change consciousness and cognition. The incidence of delirium is high in ICU, which is critically associated with increased mortality, duration of hospital stay and medical costs. As a widely used strategy in ICU, weather sedation increases the risk of delirium as well as the causative relationship between the sedative depth and delirium and prevention of delirium have drwan more and more attention in ICU. In this paper, we review the relationship between sedation and delirium, the prevention and treatment of delirium were also discussed in this review.

Sedation and analgesic should be routine used for critically ill patients. However, survey study showed that there were many ICUs that did not implement standardized sedation and analgesic. Concerning the inhibition effects of sedatives and analgesics on cardiovascular and respiratory system is the main reason that impact intensicivists to carry out sedative and analgesic approch. We will introduce the cardiovascular and respiratory manifestation of sedatives and analgesics that commonly used in ICU to guide us how to use these drugs.