Analgosedação em pacientes críticos em Unidade de Terapia Intensiva
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Publicado
Mar 31, 2025
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Resumo
Objetivo: Organizar e reunir o conteúdo de artigos científicos que ampliam a pesquisa sobre a analgosedação em pacientes críticos. Métodos: Trata-se de uma revisão integrativa, baseada nas plataformas PubMed, SCIELO, Lilacs, pesquisando os descritores "Analgesia" e "Sedação" e "Unidade de Terapia Intensiva" e o operador booleano “AND” e “OR”, com artigos publicados de 2020 a 2024, em inglês, atualizados e com informações relevantes. No total da análise, contabilizou-se 28 artigos para serem incluídos como base do presente estudo. Resultados: A dor é um fator complexo a ser tratado e manejado no ambiente de UTI, pois algumas condições podem ser agravadas devido diagnóstico e orientação inadequadas. Delirium demonstra-se como uma condição associada a piores desfechos e deve-se evitá-lo. Utiliza-se escalas e diferentes estratégias de sedoanalgesia, para melhor eficácia e segurança das mesmas. Considerações finais: Sugere-se que as interrupções diárias, menor sedoanalgesia, e o manejo multimodal impactam em tempo de internação e melhor prognóstico pós alta.
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Como Citar
PradoE. de M., PereiraB. M. de C., & FilhoJ. M. C. (2025). Analgosedação em pacientes críticos em Unidade de Terapia Intensiva. Revista Eletrônica Acervo Saúde, 25, e18964. https://doi.org/10.25248/reas.e18964.2025
Seção
Revisão Bibliográfica
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Referências
1. ARUN TC, et al. A Comparison of Analgesic and Recovery Profiles of Ketamine, Lignocaine, and Dexmedetomidine (KeLiDex) Versus Fentanyl-Based Anesthesia in Laparoscopic Nephrectomies: A Randomized, Single-Blind, Pilot Study. Cureus, 2024; 16(6).
2. BONVECCHIO E, et al. Nociception level index variations in ICU: curarized vs non-curarized patients - a pilot study. J Anesth Analg Crit Care, 2024; 4(1): 57.
3. CHANQUES G, et al. Analgesia and sedation in patients with ARDS. Intensive care medicine, 2020; 46: 2342-2356.
4. CHEN K, et al. A gap existed between physicians’ perceptions and performance of pain, agitation-sedation and delirium assessments in Chinese intensive care units. BMC anesthesiology, 2021; 21: 1-11.
5. DE BELS D, et al. Sedation for adult ICU patients: A narrative review including a retrospective study of our own data. Saudi journal of anaesthesia, 2023; 17(2): 223-235.
6. DONATO M, et al. Consensus for the management of analgesia, sedation, and delirium in adults with COVID-19-associated acute respiratory distress syndrome. Revista Brasileira de Terapia Intensiva, 2021; 33: 48-67.
7. FUCHS-BUDER T, et al. Peri-operative management of neuromuscular blockade: a guideline from the European Society of Anaesthesiology and Intensive Care. European Journal of Anaesthesiology| EJA, 2023; 40(2): 82-94.
8. GITTI N, et al. Seeking the light in intensive care unit sedation: the optimal sedation strategy for critically ill patients. Frontiers in medicine, 2022; 9: 901343.
9. HUME NE, et al. Clinical impact of the implementation strategies used to apply the 2013 pain, Agitation/Sedation, delirium or 2018 pain, Agitation/Sedation, delirium, immobility, sleep disruption guideline recommendations: a systematic review and meta-analysis. Critical care medicine, 2024; 52(4): 626-636.
10. JOHN K, et al. Impact of the Injectable Opioid Drug Shortage on Analgesia and Sedation Management in the Medical Intensive Care Unit: A Retrospective Cohort Study. Hospital Pharmacy, 2022; 57(1): 160-166.
11. KATTAN E, et al. Sedation and Analgesia for Toxic Epidermal Necrolysis in the Intensive Care Unit: Few Certainties, Many Questions Ahead. Journal of Personalized Medicine, 2023; 13(8): 1194.
12. KHATIB S, et al. Hemodynamic effects of ketamine infusion in the intensive care unit for maintenance sedation compared with propofol and midazolam: a retrospective cohort study. Ochsner Journal, 2022; 22(3): 225-229.
13. KUMPF O, et al. Quality indicators in intensive care medicine for Germany–fourth edition 2022. GMS German Medical Science, 2023; 21.
14. LIANG JF, et al. A Randomized Controlled Clinical Trial Investigating the Weaning Process From Mechanical Ventilation in Elderly Patients With Dementia. The Clinical Respiratory Journal, 2024; 18(7): 13808.
15. MART MF, et al. Prevention and management of delirium in the intensive care unit. In Seminars in respiratory and critical care medicine, Thieme Medical Publishers, Inc, 2021; 42(1): 112-126.
16. NEME D, et al. Evidence-based guideline for adult sedation, pain assessment, and analgesia in a low resource setting intensive care unit. International journal of general medicine, 2020; 1445-1452.
17. NORDNESS MF, et al. Current perspectives on the assessment and management of pain in the intensive care unit. Journal of Pain Research, 2021; 1733-1744.
18. PAULA-GARCIA WN, et al. Lidocaine combined with magnesium sulfate preserved hemodynamic stability during general anesthesia without prolonging neuromuscular blockade: a randomized, double-blind, controlled trial. BMC anesthesiology, 2021; 21: 1-8.
19. PEARSON SD e PATEL BK. Evolving targets for sedation during mechanical ventilation. Current opinion in critical care, 2020; 26(1): 47-52.
20. SCHICK B, et al. Measurement of the nociceptive flexion reflex threshold in critically ill patients–a randomized observational pilot study. BMC anesthesiology, 2021; 21(1): 270.
21. SCHIZODIMOS T, et al. An overview of management of intracranial hypertension in the intensive care unit. Journal of anesthesia, 2020; 34: 741-757.
22. SHARIF S, et al. Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials. British Journal of Anaesthesia, 2024.
23. SOSNOWSKI K, et al. Effectiveness of the ABCDEF bundle on delirium, functional outcomes, and quality of life in intensive care patients: a study protocol for a randomised controlled trial with embedded process evaluation. BMJ open, 2021; 11(7): 44814.
24. SOSNOWSKI K, et al. The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: A systematic review and meta-analysis. International journal of nursing studies, 2023; 138: 104410.
25. TARWADE P e SMISCHNEY NJ. Endotracheal intubation sedation in the intensive care unit. World Journal of Critical Care Medicine, 2022; 11(1): 33.
26. TEMESGEN N, et al. adult sedation and analgesia in a resource limited intensive care unit–a systematic review and evidence-based guideline. Annals of medicine and surgery, 2021; 66: 102356.
27. WONG IM, et al. Sedation and delirium in the intensive care unit-a practice-based approach. Ann Acad Med Singap, 2020; 49(4): 215-225.
28. XIE K, et al. Postoperative infusion of dexmedetomidine via intravenous patient-controlled analgesia for prevention of postoperative delirium in elderly patients undergoing surgery. Aging Clinical and Experimental Research, 2023; 35(10): 2137-2144.
2. BONVECCHIO E, et al. Nociception level index variations in ICU: curarized vs non-curarized patients - a pilot study. J Anesth Analg Crit Care, 2024; 4(1): 57.
3. CHANQUES G, et al. Analgesia and sedation in patients with ARDS. Intensive care medicine, 2020; 46: 2342-2356.
4. CHEN K, et al. A gap existed between physicians’ perceptions and performance of pain, agitation-sedation and delirium assessments in Chinese intensive care units. BMC anesthesiology, 2021; 21: 1-11.
5. DE BELS D, et al. Sedation for adult ICU patients: A narrative review including a retrospective study of our own data. Saudi journal of anaesthesia, 2023; 17(2): 223-235.
6. DONATO M, et al. Consensus for the management of analgesia, sedation, and delirium in adults with COVID-19-associated acute respiratory distress syndrome. Revista Brasileira de Terapia Intensiva, 2021; 33: 48-67.
7. FUCHS-BUDER T, et al. Peri-operative management of neuromuscular blockade: a guideline from the European Society of Anaesthesiology and Intensive Care. European Journal of Anaesthesiology| EJA, 2023; 40(2): 82-94.
8. GITTI N, et al. Seeking the light in intensive care unit sedation: the optimal sedation strategy for critically ill patients. Frontiers in medicine, 2022; 9: 901343.
9. HUME NE, et al. Clinical impact of the implementation strategies used to apply the 2013 pain, Agitation/Sedation, delirium or 2018 pain, Agitation/Sedation, delirium, immobility, sleep disruption guideline recommendations: a systematic review and meta-analysis. Critical care medicine, 2024; 52(4): 626-636.
10. JOHN K, et al. Impact of the Injectable Opioid Drug Shortage on Analgesia and Sedation Management in the Medical Intensive Care Unit: A Retrospective Cohort Study. Hospital Pharmacy, 2022; 57(1): 160-166.
11. KATTAN E, et al. Sedation and Analgesia for Toxic Epidermal Necrolysis in the Intensive Care Unit: Few Certainties, Many Questions Ahead. Journal of Personalized Medicine, 2023; 13(8): 1194.
12. KHATIB S, et al. Hemodynamic effects of ketamine infusion in the intensive care unit for maintenance sedation compared with propofol and midazolam: a retrospective cohort study. Ochsner Journal, 2022; 22(3): 225-229.
13. KUMPF O, et al. Quality indicators in intensive care medicine for Germany–fourth edition 2022. GMS German Medical Science, 2023; 21.
14. LIANG JF, et al. A Randomized Controlled Clinical Trial Investigating the Weaning Process From Mechanical Ventilation in Elderly Patients With Dementia. The Clinical Respiratory Journal, 2024; 18(7): 13808.
15. MART MF, et al. Prevention and management of delirium in the intensive care unit. In Seminars in respiratory and critical care medicine, Thieme Medical Publishers, Inc, 2021; 42(1): 112-126.
16. NEME D, et al. Evidence-based guideline for adult sedation, pain assessment, and analgesia in a low resource setting intensive care unit. International journal of general medicine, 2020; 1445-1452.
17. NORDNESS MF, et al. Current perspectives on the assessment and management of pain in the intensive care unit. Journal of Pain Research, 2021; 1733-1744.
18. PAULA-GARCIA WN, et al. Lidocaine combined with magnesium sulfate preserved hemodynamic stability during general anesthesia without prolonging neuromuscular blockade: a randomized, double-blind, controlled trial. BMC anesthesiology, 2021; 21: 1-8.
19. PEARSON SD e PATEL BK. Evolving targets for sedation during mechanical ventilation. Current opinion in critical care, 2020; 26(1): 47-52.
20. SCHICK B, et al. Measurement of the nociceptive flexion reflex threshold in critically ill patients–a randomized observational pilot study. BMC anesthesiology, 2021; 21(1): 270.
21. SCHIZODIMOS T, et al. An overview of management of intracranial hypertension in the intensive care unit. Journal of anesthesia, 2020; 34: 741-757.
22. SHARIF S, et al. Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials. British Journal of Anaesthesia, 2024.
23. SOSNOWSKI K, et al. Effectiveness of the ABCDEF bundle on delirium, functional outcomes, and quality of life in intensive care patients: a study protocol for a randomised controlled trial with embedded process evaluation. BMJ open, 2021; 11(7): 44814.
24. SOSNOWSKI K, et al. The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: A systematic review and meta-analysis. International journal of nursing studies, 2023; 138: 104410.
25. TARWADE P e SMISCHNEY NJ. Endotracheal intubation sedation in the intensive care unit. World Journal of Critical Care Medicine, 2022; 11(1): 33.
26. TEMESGEN N, et al. adult sedation and analgesia in a resource limited intensive care unit–a systematic review and evidence-based guideline. Annals of medicine and surgery, 2021; 66: 102356.
27. WONG IM, et al. Sedation and delirium in the intensive care unit-a practice-based approach. Ann Acad Med Singap, 2020; 49(4): 215-225.
28. XIE K, et al. Postoperative infusion of dexmedetomidine via intravenous patient-controlled analgesia for prevention of postoperative delirium in elderly patients undergoing surgery. Aging Clinical and Experimental Research, 2023; 35(10): 2137-2144.