Multimodal Analgesi og Remifentanilforbrug i Intensivbehandling
Intensivpatienter under mekanisk ventilation oplever ofte varierende grader af smerte, og der er et behov for effektive multimodale analgesi-strategier for at minimere opioidforbruget og relaterede bivirkninger. Studiet, “Opioid-Free Analgesia in Intensive Care Unit,” har til formål at vurdere gennemførligheden af en standardiseret multimodal analgesi-strategi samt dens fordele ved reduktion af remifentanilforbrug hos ICU-patienter [source_link].
Studiet er designet som en randomiseret, placebo-kontrolleret, dobbeltblind feasibility-trial, hvor 50 mekanisk ventilerede voksne patienter vil blive rekrutteret. Deltagerne vil blive opdelt i to grupper: interventionsgruppen vil modtage en standardiseret multimodal analgesi, der indledningsvis omfatter nefopam og tramadol, og ketamin vil blive tilføjet, hvis smerter fortsætter. Remifentanil vil kun blive anvendt med stigende doser ved utilstrækkelig analgesi. Kontrollgruppen vil modtage remifentanil som primær smertelindring med graduerede doser for at opnå analgesi.
Det primære endepunkt for studiet er det daglige forbrug af remifentanil mellem den 24. og 48. time efter inklusion. Sekundære endepunkter vil omfatte lægemiddel-tolerance, varighed af mekanisk ventilation, længde af ICU- og hospitalsophold, samt 28-dages og 90-dages mortalitet og opioidforbrug inden for 90 dage. Data vil blive analyseret med henblik på at sammenligne resultaterne mellem de to grupper.
Dette er en AI-genereret oversættelse og opsummering. Læseren bør konsultere den originale kilde for validering og ikke træffe kliniske beslutninger udelukkende på baggrund af dette resumé.
#Anæstesiologi #Akutmedicin #Intensivmedicin #Klinisk farmakologi
Læs hele studiet her: [source_link]
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**Title:** Opioid-Free Analgesia in Intensive Care Unit Study
**Journal:** BMJ Open
**Publication Date:** January 20, 2025
**Volume:** 15
**Issue:** 1
**Article ID:** e090396
**DOI:** [10.1136/bmjopen-2024-090396](https://doi.org/10.1136/bmjopen-2024-090396)
**PMID:** 39832962
**PMCID:** PMC11749888
**Affiliations:**
1. Division of Anesthesia Critical Care, Emergency and Pain Medicine, University Hospital Centre Nimes, Nimes, Occitanie, France. Email: remywdm@gmail.com
2. Division of Anesthesia Critical Care, Emergency and Pain Medicine, University Hospital Centre Nimes, Nimes, Occitanie, France.
3. Department of Pharmacy, Centre Hospitalier Universitaire de Nimes, Nimes, Languedoc-Roussillon, France.
4. Department of Pharmacy, University Hospital Centre Nimes, Nimes, Occitanie, France.
**Abstract:**
– **Introduction:** ICU patients on mechanical ventilation often experience pain ranging from mild to severe. Multimodal analgesia is recommended to reduce opioid use and related side effects. This study aims to evaluate the feasibility of a standardized multimodal analgesia strategy and its effects on remifentanil usage in ICU patients.
– **Methods and Analysis:** A randomized, placebo-controlled, double-blind trial will enroll 50 mechanically ventilated adult patients. The intervention group will receive a multimodal analgesia regimen starting with nefopam and tramadol, adding ketamine if needed, and gradually incorporating remifentanil for inadequate analgesia. The control group will receive escalating doses of remifentanil. The primary outcome is daily remifentanil consumption between 24-48 hours after inclusion. Secondary outcomes include drug tolerance, duration of mechanical ventilation, ICU and hospital length of stay, and mortality rates at 28 and 90 days.
– **Ethics and Dissemination:** The study has received approval from the Nîmes University Hospital’s research committee, the French ethics committee (Institutional Review Board OUEST IV), and the French National Agency for the Safety of Medicines and Health Products (ANSM).
**Trial Registration Number:** NCT05825560
**Keywords:** Adult intensive & critical care; Pain Management; Intensive Care Units; Analgesia; Multimodal analgesia; Opioid-sparing strategies.
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