Repercussões da sedação em pacientes internados em unidades de terapia intensiva: uma revisão sistemática
Repercussions of sedation in hospitalized patients in intensive care units: a systematic review
Priscylla de Azevedo Silva Basto, Yasmin de Oliveira Soares, Hudhane Santos de Oliveira, Willian de Souza Gonçalves, Luciana Fernandes Balestra, Giulliano Gardenghi
Resumo
Introdução: A sedação é um ato médico realizado, mediante utilização de medicamentos, com o objetivo de proporcionar conforto ao paciente. A maioria dos pacientes internados em Unidades de Terapia Intensiva (UTI) necessita de sedação, em algum momento durante sua internação, principalmente, quando submetidos à intubação orotraqueal e, consequentemente, à ventilação mecânica. Objetivo: O presente estudo trata de uma revisão sistemática e tem por objetivo verificar a aplicabilidade e as repercussões das técnicas de sedação e de seu respectivo desmame, analisando seus efeitos em pacientes sob ventilação mecânica em UTI. Métodos: Foi realizada uma revisão sistemática de estudos publicados entre os anos de 1993 a 2013, utilizando as bases de dados PubMed, Scielo e Google Acadêmico, empregando, como palavras chave, sedação, ventilação mecânica, unidades de terapia intensiva e agitação. Resultados: Observou-se que, na maioria dos casos em que o paciente necessitou de prótese endotraqueal, o tempo de sedação foi primordial para determinar o tempo de permanência do tubo. Protocolos que realizaram suspensão diária da sedação, em sua maioria, foram mais eficazes em proporcionar a extubação precoce dos indivíduos ventilados, quando comparados a outras formas de administração da sedação. A sedação do paciente utilizando propofol ou dexmedetomidina parece encurtar o tempo de ventilação mecânica, quando comparada com outros sedativos. Maior permanência em UTI, sob ventilação mecânica e sob efeito de sedação, foi relacionada com maiores complicações. Conclusão: O uso prolongado de sedação foi relacionado a eventos adversos, como aumento nos tempos de ventilação mecânica e de internação, maiores custos e maior incidência de degeneração muscular e cutânea, além de maiores taxas de mortalidade, entre outros.
Palavras-chave
Abstract
Introduction: Sedation is a medical act performed by the use of drugs aiming to provide comfort to the patient. Most of the intubated patients in intensive care units (ICU) will receive some sort of sedation during their hospital length of stay, especially when submitted to orotracheal intubation and consequently, to mechanical ventilation. Objetive: The present study is a systematic review and aims to report on the use and the repercussions of several sedation techniques and also report on their weaning, analyzing its effects in patients who underwent mechanical ventilation in ICU. Methods: A systematic review of studies published from 1993 to 2013 was conducted, searching the following databases: PubMed, Scielo and Academic Google and using as keywords sedation, mechanical ventilation, intensive care units and agitation. Results: In most of the cases when the patient required endotracheal tubes, the duration of sedation was essential to determine the chest tube duration. Many protocols performed daily suspension of sedation and these were more effective in order to promote the extubation of patients, when compared with other forms of sedation administering. The use of sedatives as propofol and dexmedetomidine seems to shorten the length of mechanical ventilation, when compared with other drugs. Longer permanence in ICU under mechanical ventilation and under sedation effects was related to major complications. Conclusion: Prolonged use of sedation was related to adverse events such as the increased time under mechanical ventilation, increased hospital length of stay, increased costs, higher degeneration of muscular and skin tissues as well as higher mortality rates, among others complications.
Keywords
Referências
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