Remifentanil for analgesia and sedation in mechanically ventilated patients in intensive care unit

Abstract

To prospectively assess the effect of remifentanil for analgesia and sedation, the impact on sustenance duration of mechanical ventilation and hemodynamics, and also its adverse reaction in the mechanically ventilated patients in the intensive care unit (ICU). Sixty patients with invasive mechanical ventilation forever 24 hours after tumor operation were randomly allocated to fentanyl group (n = 30) or remifentanil group n = 30) to receive a persistent infusion of either fentanyl or remifentanil for sedation and analgesia. The level of analgesia was assessed according to facial pain scale (FPS), while the level of sedation was assessed according to the Ramsay score (RS). A propofol infusion was started if additional sedation was necessary. During the therapy, the daily awakening procedure was performed, and the scores of FPS and RS and the vital signs were recorded respectively before and after medication. The number of patients receiving additional propofol infusion, and number of daily interruption of medication and that of daily arousal, the duration of mechanical ventilation, ICU length of stay, and ICU cost were recorded. Furthermore, the incidence of adverse reactions was documented. The ideal targets of analgesia and sedation were reached in both groups. There were nearly no significant differences between the groups with respect to the effect of sedation and analgesia. However, the FPS scores in fentanyl group at the 30 minutes of the medication were. obviously higher than those of remifentanil group (3. 70 ± 1.20 vs. 2.70 ± 1.17, P<0.05). The mean arterial pressure (MAP,mm Hg, I mm Hg = 0.133 kPa) of remifentanil group at 30 minutes was significantly lower than that of fentanyl group (72.9 ± 6.9 vs. 77.6 ± 9.1, P<0.05). There was no difference between two groups with respect to the other vital signs. More patients in fentanyl group needed the additional propofol infusion (9 vs. 8) and interruption of medication (12 vs. 4, both P<0.05). The spontaneous breathing frequency (RRs, bpm) in patients of remifentanil group was lower obviously at 30 minutes and 1, 6, 24 hours than that of fentanyl group (7.0 ± 2.8 vs. 10.4 ± 3.5, 5.4 ± 3.4 vs. 10.6 ± 3.6, 5.4 ± 3.0 vs. 7.2 ± 3.1 , 6.1 ± 3.0 vs. 9.2 ± 3.4, all P< 0.05) . The duration of mechanical ventilation (hours) and ICU length of stay (hours) were shortened in remifentanil group comparted with fentanyl group (73.6 ± 26.7 vs. 94.9 ± 37.3, 125.9 ± 37.1 vs. 150.8 ± 50.9, both P<0.05). With respect to the cost of hospitalization (10 thousand), no significant difference was found between two groups (6.06 ± 2.29 vs. 5.83 ± 2.38, P>0.05). The number of patients showing hypotension was much more in remifentanil group than that of fentanyl group (8 vs. 2, P<0.05). The effect of remifentanil was similar to that of the conventional therapy. Remifentanil gives rapid effect, shortens the duration of mechanical ventilation, reduces the dosage of propofol, and has no severe adverse effect.