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  • Poster presentation
  • Open Access

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

  • 1,
  • 2,
  • 3,
  • 4,
  • 5,
  • 6 and
  • 7
Critical Care20048 (Suppl 1) :P237

https://doi.org/10.1186/cc2704

  • Published:

Keywords

  • Morphine
  • Mechanical Ventilation
  • Fentanyl
  • Midazolam
  • Remifentanil

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

 

RBA (n = 57)

HBS (n = 48)

Total AEs

19 (33%)

16 (33%)

Total serious AEs

7 (12%)

6 (13%)

Hypotension*

3 (5%)

4 (8%)

Atrial fibrillation*

4 (7%)

2 (4%)

Septic shock*

0

3 (6%)

Vomiting*

3 (5%)

0

*Most common AEs.

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.

Authors’ Affiliations

(1)
General Hospital, Athens, Greece
(2)
ACZA Campus Stuivenberg, Antwerpen, Belgium
(3)
Isala Klinieken, Zwolle, The Netherlands
(4)
Rigshospitalet, Blegdamsvej, Denmark
(5)
Department of Anaesthesiology, Intensive Medicine, Vienna, Austria
(6)
Royal Hallamshire Hospital, Sheffield, UK
(7)
GlaxoSmithKline, Greenford, UK

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