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Remifentanil-based analgesia and sedation is well tolerated when administered for up to 10 days in mechanically ventilated ICU patients

Introduction

Remifentanil's titratability and rapid organ-independent metabolism make it ideally suited for use in critically ill patients. Establishing safety in this population is important as studies of remifentanil for greater than 3 days are limited. This study compared the safety and efficacy of remifentanil-based analgesia and sedation (RBA) with hypnotic-based sedation (HBS), in 105 ICU patients with medical conditions requiring long-term (up to 10 days) mechanical ventilation.

Methods

One hundred and five patients were randomised to receive either RBA or HBS. Remifentanil infusion started at 6–9 μg/kg/hour and was titrated to effect to provide optimal analgesia and sedation. Supplemental midazolam (MID) bolus was introduced to remifentanil at a rate of 12–18 μg/kg/hour. HBS (MID + fentanyl or morphine at investigator's choice) was administered according to routine clinical practice. Adverse events (AEs) were recorded throughout the treatment and post-treatment period.

Results

No clinical differences were observed in the incidence of adverse events. Seventeen patients received RBA and 16 patients received HBS for at least 10 days. Table 1 presents the AEs.

Table 1 Table 1

Conclusions

Remifentanil is well tolerated when used for periods of up to 10 days in intensive care patients on mechanical ventilation. No adverse events relating to prolonged recovery from mu-opioid effects were reported.

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Karabinis, A., Malbrain, M., Bakker, J. et al. Remifentanil-based analgesia and sedation is well tolerated when administered for up to 10 days in mechanically ventilated ICU patients. Crit Care 8, P237 (2004). https://doi.org/10.1186/cc2704

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Keywords

  • Morphine
  • Mechanical Ventilation
  • Fentanyl
  • Midazolam
  • Remifentanil