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  1. Article ; Online: Intensive Care Unit-acquired infection as a side effect of sedation.

    Nseir, Saad / Makris, Demosthenes / Mathieu, Daniel / Durocher, Alain / Marquette, Charles-Hugo

    Critical care (London, England)

    2010  Volume 14, Issue 2, Page(s) R30

    Abstract: ... Several epidemiologic studies suggested a link between sedation and ICU-acquired infection. Prolongation of exposure ... of a particular agent to reduce ICU-acquired infection rate. However, sedation strategies aiming to reduce ... immunomodulatory effects are main mechanisms by which sedation may favour infection in critically ill patients ...

    Abstract Introduction: Sedative and analgesic medications are routinely used in mechanically ventilated patients. The aim of this review is to discuss epidemiologic data that suggest a relationship between infection and sedation, to review available data for the potential causes and pathophysiology of this relationship, and to identify potential preventive measures.
    Methods: Data for this review were identified through searches of PubMed, and from bibliographies of relevant articles.
    Results: Several epidemiologic studies suggested a link between sedation and ICU-acquired infection. Prolongation of exposure to risk factors for infection, microaspiration, gastrointestinal motility disturbances, microcirculatory effects are main mechanisms by which sedation may favour infection in critically ill patients. Furthermore, experimental evidence coming from studies both in humans and animals suggest that sedatives and analgesics present immunomodulatory properties that might alter the immunologic response to exogenous stimuli. Clinical studies comparing different sedative agents do not provide evidence to recommend the use of a particular agent to reduce ICU-acquired infection rate. However, sedation strategies aiming to reduce the duration of mechanical ventilation, such as daily interruption of sedatives or nursing-implementing sedation protocol, should be promoted. In addition, the use of short acting opioids, propofol, and dexmedetomidine is associated with shorter duration of mechanical ventilation and ICU stay, and might be helpful in reducing ICU-acquired infection rates.
    Conclusions: Prolongation of exposure to risk factors for infection, microaspiration, gastrointestinal motility disturbances, microcirculatory effects, and immunomodulatory effects are main mechanisms by which sedation may favour infection in critically ill patients. Future studies should compare the effect of different sedative agents, and the impact of progressive opioid discontinuation compared with abrupt discontinuation on ICU-acquired infection rates.
    MeSH term(s) Cross Infection/epidemiology ; Cross Infection/etiology ; Deep Sedation/adverse effects ; Humans ; Intensive Care Units ; Risk Assessment
    Language English
    Publishing date 2010
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2051256-9
    ISSN 1466-609X ; 1466-609X
    ISSN (online) 1466-609X
    ISSN 1466-609X
    DOI 10.1186/cc8907
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Remifentanil discontinuation and subsequent intensive care unit-acquired infection: a cohort study.

    Nseir, Saad / Hoel, Jérémy / Grailles, Guillaume / Soury-Lavergne, Aude / Di Pompeo, Christophe / Mathieu, Daniel / Durocher, Alain

    Critical care (London, England)

    2009  Volume 13, Issue 2, Page(s) R60

    Abstract: ... discontinuation on intensive care unit (ICU)-acquired infection.: Methods: This was a prospective observational ... analyses were performed to determine risk factors for ICU-acquired infection.: Results: Five hundred and ... infection was diagnosed in 233 (39%) patients. Incidence rate of ICU-acquired infection was 38 per 1000 ICU ...

    Abstract Introduction: Recent animal studies demonstrated immunosuppressive effects of opioid withdrawal resulting in a higher risk of infection. The aim of this study was to determine the impact of remifentanil discontinuation on intensive care unit (ICU)-acquired infection.
    Methods: This was a prospective observational cohort study performed in a 30-bed medical and surgical university ICU, during a one-year period. All patients hospitalised in the ICU for more than 48 hours were eligible. Sedation was based on a written protocol including remifentanil with or without midazolam. Ramsay score was used to evaluate consciousness. The bedside nurse adjusted sedative infusion to obtain the target Ramsay score. Univariate and multivariate analyses were performed to determine risk factors for ICU-acquired infection.
    Results: Five hundred and eighty-seven consecutive patients were included in the study. A microbiologically confirmed ICU-acquired infection was diagnosed in 233 (39%) patients. Incidence rate of ICU-acquired infection was 38 per 1000 ICU-days. Ventilator-associated pneumonia was the most frequently diagnosed ICU-acquired infection (23% of study patients). Pseudomonas aeruginosa was the most frequently isolated microorganism (30%). Multivariate analysis identified remifentanil discontinuation (odds ratio (OR) = 2.53, 95% confidence interval (CI) = 1.28 to 4.99, P = 0.007), simplified acute physiology score II at ICU admission (1.01 per point, 95% CI = 1 to 1.03, P = 0.011), mechanical ventilation (4.49, 95% CI = 1.52 to 13.2, P = 0.006), tracheostomy (2.25, 95% CI = 1.13 to 4.48, P = 0.021), central venous catheter (2.9, 95% CI = 1.08 to 7.74, P = 0.033) and length of hospital stay (1.05 per day, 95% CI = 1.03 to 1.08, P < 0.001) as independent risk factors for ICU-acquired infection.
    Conclusions: Remifentanil discontinuation is independently associated with ICU-acquired infection.
    MeSH term(s) Adult ; Aged ; Analgesics, Opioid/administration & dosage ; Cross Infection/epidemiology ; Cross Infection/etiology ; Cross Infection/microbiology ; Female ; France/epidemiology ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Middle Aged ; Observation ; Piperidines/administration & dosage ; Prospective Studies ; Remifentanil ; Risk Factors
    Chemical Substances Analgesics, Opioid ; Piperidines ; Remifentanil (P10582JYYK)
    Language English
    Publishing date 2009-04-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/cc7788
    Database MEDical Literature Analysis and Retrieval System OnLINE

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