Guiding Sufentanil Administration With Skin Conductance in Mechanically Ventilated Intensive Care Patients
Study Details
Study Description
Brief Summary
Opioid administration in mechanically ventilated patients in the intensive care unit (ICU) is essential to maintaining patient respiratory and hemodynamic stability. Mechanical ventilation is a persistently nociceptive event that can continuously causes discomfort in the trachealy intubated patient. This can lead to patient-ventilator dyssynchrony, tachycardia, hypertension, and their associated complications. Opioids blunt respiratory drive, which facilitates mechanical ventilation, and decrease the sympathetic response to nociception. However, excessive opiate administration is associated with many adverse events, including respiratory depression, delirium, ileus, nausea, and vomiting. Currently, the standard administration in our institution of sufentanil, a potent opiate, consists of continuous infusions of 0.15µg/kg/h to 0.3µg/kg/h.
Mechanically ventilated patients are unable to speak and are often sedated. This greatly impacts the patient's capacity to communicate pain. The use of a nociceptive monitor may be a possible solution. Skin conductance monitoring (Pain Monitor, Med-Storm, Norway), measures the peaks per second of electrical conduction. This non hemodynamic monitor uses skin conduction as a surrogate to nociception (i.e., the patient's unconscious response to a noxious stimulus). It may consequently guide opioid administration in ICU patients towards and avoid the consequences of excessive or inadequate antinociception.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Skin conductance guided Sufentanil is titrated by the intensive care team to maintain skin conductance in target |
Procedure: Skin conductance guided antinociception
The value of skin conductance guides the titration of sufentanil
|
| Active Comparator: Standard care Sufentanil is titrated at the discretion of the intensivist |
Procedure: Standard care antinociception
The intensive care team titrates antinociception based on their standard approach (using a clinical approach by assessing blood pressure, heart rate, and ventilator dyssynchrony).
|
Outcome Measures
Primary Outcome Measures
- Concentration of sufentanil requirements [one day to 2 weeks]
Sufentanil requirements (µg/kg/h)
Secondary Outcome Measures
- Concentration of propofol requirements [one day to 2 weeks]
Propofol requirements (mg/kg/h)
- Concentration of noradrenaline requirements (concentration of) [one day to 2 weeks]
noradrenaline requirements (µg/kg/min)
- Intubation time [one day to 2 weeks]
Total time of mechanical ventilation (intubated)
- Composite post extubation related complications [one day to 2 weeks]
post extubation opioid related complications (e.g., delirium, vomiting, nausea, ileus, respiratory acidosis, hypoxemia, reintubation).
Eligibility Criteria
Criteria
Inclusion Criteria:
- Adult patient admitted to the ICU requiring endotracheal intubation, antinociception, and sedation
Exclusion Criteria:
-
Traumatic brain injury
-
use of ketamine, dexmedetomidine, or clonidine
-
pregnancy
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Erasme University Hospital
Investigators
- Principal Investigator: Fabio Taccone, Université Libre de Bruxelles
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- P2020/402 / B4062020000124