PMID- 22170974
OWN - NLM
STAT- MEDLINE
DCOM- 20120604
LR  - 20151119
IS  - 1542-6270 (Electronic)
IS  - 1060-0280 (Linking)
VI  - 46
IP  - 1
DP  - 2012 Jan
TI  - Sedation and analgesia usage in severe pandemic H1N1 (2009) infection: a 
      comparison to respiratory failure secondary to other infectious pneumonias.
PG  - 9-20
LID - 10.1345/aph.1Q446 [doi]
AB  - BACKGROUND: During the 2009 H1N1 pandemic (pH1N1), patients requiring mechanical 
      ventilation for respiratory failure received high doses of sedation and 
      analgesia. OBJECTIVE: To examine sedation and analgesia use among patients with 
      respiratory failure due to severe pH1N1 infection compared to other infectious 
      pneumonias. METHODS: In this observational cohort study of intensive care unit 
      (ICU) patients with respiratory failure, we compared doses of sedatives and 
      analgesics administered to patients with pH1N1, non-pH1N1 viral pneumonia, and 
      adult respiratory distress syndrome (ARDS) secondary to bacterial pneumonia, on 
      days 1, 3, 7, 14, and 28 of ICU admission. Cumulative drug use, daily drug use, 
      and weight-adjusted medication doses were examined. RESULTS: The study population 
      consisted of 37 patients with pH1N1 infection, 22 patients with non-pH1N1 viral 
      pneumonia, and 46 patients with ARDS secondary to bacterial pneumonia. To achieve 
      similar levels of sedation using the Richmond Agitation Sedation Scale, patients 
      with pH1N1 were administered the highest cumulative median doses of fentanyl 
      (11,230 mug; interquartile range [IQR] 3240-21,000), compared to 2400 mug (IQR 
      130-7130) in viral pneumonia and 2880 mug (IQR 600-6950) in ARDS (p < 0.001). 
      Patients with pH1N1 were also administered the highest cumulative median doses of 
      midazolam at 820 mg (IQR 330-1160), compared to 160 mg (IQR 20-390) in viral 
      pneumonia and 160 mg (IQR 20-480 mg) in ARDS (p < 0.001). The pH1N1 group 
      received the highest median daily fentanyl and midazolam doses on all study days. 
      The pH1N1 group did not differ significantly in cumulative propofol dose compared 
      with the other 2 study groups. CONCLUSIONS: Sedative and analgesic use may be 
      uniquely higher in critically ill patients with pH1N1 infection compared to 
      patients with other infectious pneumonias. This finding may be important for 
      resource planning in future pandemics. Further study is required to explore the 
      underlying mechanisms for potentially higher sedative and analgesic requirements 
      in this patient population.
FAU - Olafson, Kendiss
AU  - Olafson K
AD  - Section of Critical Care, Department of Medicine, University of Manitoba, 
      Winnipeg, MB, Canada.
FAU - Ramsey, Clare D
AU  - Ramsey CD
FAU - Ariano, Robert E
AU  - Ariano RE
FAU - Stasiuk, Allison
AU  - Stasiuk A
FAU - Siddiqui, Faisal
AU  - Siddiqui F
FAU - Wong, Davie
AU  - Wong D
FAU - Guinn, Aaron
AU  - Guinn A
FAU - Braun, Joel
AU  - Braun J
FAU - Kumar, Anand
AU  - Kumar A
FAU - Zarychanski, Ryan
AU  - Zarychanski R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111213
PL  - United States
TA  - Ann Pharmacother
JT  - The Annals of pharmacotherapy
JID - 9203131
RN  - 0 (Analgesics)
RN  - 0 (Hypnotics and Sedatives)
SB  - IM
MH  - Adult
MH  - Analgesics/administration & dosage/*therapeutic use
MH  - Cohort Studies
MH  - Critical Care/methods
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Hypnotics and Sedatives/administration & dosage/*therapeutic use
MH  - *Influenza A Virus, H1N1 Subtype/isolation & purification
MH  - Influenza, Human/*drug therapy/epidemiology/psychology/virology
MH  - Intensive Care Units
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Pandemics
MH  - Pneumonia, Bacterial/drug therapy/psychology
MH  - Pneumonia, Viral/*drug therapy/epidemiology/psychology/therapy/virology
MH  - Respiration, Artificial
MH  - Respiratory Insufficiency/*drug therapy/etiology/psychology/therapy
MH  - Treatment Outcome
EDAT- 2011/12/16 06:00
MHDA- 2012/06/05 06:00
CRDT- 2011/12/16 06:00
PHST- 2011/12/16 06:00 [entrez]
PHST- 2011/12/16 06:00 [pubmed]
PHST- 2012/06/05 06:00 [medline]
AID - aph.1Q446 [pii]
AID - 10.1345/aph.1Q446 [doi]
PST - ppublish
SO  - Ann Pharmacother. 2012 Jan;46(1):9-20. doi: 10.1345/aph.1Q446. Epub 2011 Dec 13.