Journal article
Daily sedative interruption in mechanically ventilated patients at risk for coronary artery disease
Critical care medicine, Vol.35(2), pp.365-371
2007
DOI: 10.1097/01.CCM.0000254334.46406.B3
PMID: 17205005
Abstract
Objectives: To determine the prevalence of myocardial ischemia in mechanically ventilated patients with coronary risk factors and compare periods of sedative interruption vs. sedative infusion.
Design: Prospective, blinded observational study.
Setting: Medical intensive care unit of tertiary care medical center.
Patients: Intubated, mechanically ventilated patients with established coronary artery disease risk factors.
Interventions: Continuous three-lead Holter monitors with ST-segment analysis by a blinded cardiologist were used to detect myocardial ischemia. Ischemia was defined as ST-segment elevation or depression of >0.1 mV from baseline.
Measurements and main results: Comparisons between periods of awakening from sedation vs. sedative infusion were made. Vital signs, catecholamine levels, and time with ischemia detected by Holter monitor during the two periods were compared. Heart rate, mean arterial pressure, rate-pressure product, respiratory rate, and catecholamine levels were all significantly higher during sedative interruption. Eighteen of 74 patients (24%) demonstrated ischemic changes. Patients with myocardial ischemia had a longer intensive care unit length of stay (17.4+/-17.5 vs. 9.6+/-6.7 days, p=.04). Despite changes in vital signs and catecholamine levels during sedative interruption, fraction of ischemic time did not differ between the time awake vs. time sedated [median [interquartile range] of 0% [0, 0] compared with 0% [0, 0] while they were sedated [p=.17]). The finding of similar fractions of ischemic time between awake and sedated states persisted with analysis of the subgroup of 18 patients with ischemia.
Conclusions: Myocardial ischemia is common in critically ill mechanically ventilated patients with coronary artery disease risk factors. Daily sedative interruption is not associated with an increased occurrence of myocardial ischemia in these patients.
Details
- Title: Subtitle
- Daily sedative interruption in mechanically ventilated patients at risk for coronary artery disease
- Creators
- John P KRESS - Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United StatesAjeet G VINAYAK - Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United StatesJoseph LEVITT - Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United StatesWilliam D SCHWEICKERT - Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United StatesBrian K GEHLBACH - Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United StatesFrank ZIMMERMAN - Section of Cardiology Department of Medicine, University of Chicago, Chicago, IL, United StatesAnne S POHLMAN - Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United StatesJesse B HALL - Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.35(2), pp.365-371
- Publisher
- Lippincott; Hagerstown, MD
- DOI
- 10.1097/01.CCM.0000254334.46406.B3
- PMID
- 17205005
- ISSN
- 0090-3493
- eISSN
- 1530-0293
- Language
- English
- Date published
- 2007
- Academic Unit
- Neurology; Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984020999902771
Metrics
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