RESUMEN
Lighter sedation targets over the past decade have resulted in improved outcomes for critically ill populations. Although guidelines exist for the general ICU population, these recommendations often exclude the burn population. The purpose of this study is to assess the impact of the initial continuous sedative on coma- and delirium-free days in critically ill patients with burns. This retrospective cohort study evaluated adult patients admitted to a burn intensive care unit at an academic medical center between January 2010 and September 2019. Patients were enrolled into 3 groups based on the depth of initial continuous sedation received (deep, light, or analgosedation). Intubated patients were randomly assessed for inclusion from the National V6 Burn Registry. Patients were included if they received a continuous sedative infusion for at least 48 h. A total of 107 patients were included in the study with 36, 41, and 30 patients receiving deep, light, and analgosedation, respectively. The primary outcome of coma- and delirium-free days was significantly different between sedation types with the most days free in analgosedation and the fewest in deep sedation (8 versus 3 days; P = 0.024). The composite primary outcome was divided into secondary outcomes of coma-free days and delirium-free days, with coma-free days being different (P = 0.00008). Other secondary outcomes of length of stay in the intensive care unit and hospital, time on mechanical ventilation, and survival to discharge were not statistically significant; however, a trend toward higher mortality in deep sedation was noted.
Asunto(s)
Quemaduras , Delirio , Adulto , Humanos , Hipnóticos y Sedantes/uso terapéutico , Coma/etiología , Coma/terapia , Estudios Retrospectivos , Enfermedad Crítica , Delirio/tratamiento farmacológico , Delirio/etiología , Delirio/epidemiología , Quemaduras/complicaciones , Quemaduras/terapia , Unidades de Cuidados Intensivos , Respiración Artificial , Tiempo de InternaciónRESUMEN
Opioidsâ¯are theâ¯mainstay of treatment for burn pain. However, these medications may be associated with respiratory depression and dependence. Multimodal analgesia is an alternative method that utilizes both opioid and nonopioid medications with different mechanisms.â¯This study examines the impact of multimodal therapy for postoperative pain control in a burn intensive care unit.⯠This was a retrospective cohort study of patients admitted to the burn unit at a tertiary medical center. Consecutively admitted patients with burns greater than or equal to 10% TBSA and intensive care unit length of stay greater than 7 days were eligible for inclusion (2012-2018). Patients were excluded if they received an opioid infusion greater than 48 hours.⯠Patients treated with multimodal analgesia were compared to those treated with opioids alone. Data were calculated for 5 days after surgery. There were 98â¯patients in the nonmultimodal group and 97â¯in the multimodal group. Mean cumulative opioid dose was lower in the multimodal group (1028.7 mg vs 1423.2 mg,â¯P = .0031). Patients with greater than 20% burns hadâ¯a larger reduction inâ¯mean opioid equivalents in the multimodal group (1106 vs 1594 mg, P = .009) compared to patients with burns less than 20% (940 vs 1282 mg, P = .058). There was no difference in mean pain scores on postoperative day 5 (6.2⯱â¯2.2 vs 5.5⯱â¯2.3, P = .07)â¯or at intensive care unit discharge (4.7⯱â¯2.4â¯vsâ¯4.7⯱â¯2.8, P = .99). The use of multimodal analgesia significantly reduced cumulative opioid equivalent dose without compromising pain control.â¯â¯â¯â¯.