%0 Journal Article
%T Are we sedating more than just the brain?
%A Nathan E Brummel
%A Timothy D Girard
%J Critical Care
%D 2011
%I BioMed Central
%R 10.1186/cc10233
%X ICU patients are often sedated to prevent pain and anxiety and to facilitate care. Heavy sedation, however, is associated with adverse effects, including prolonged mechanical ventilation, ICU and hospital stays, and increased mortality [1-5]. Nevertheless, deep sedation is frequently used [6], exposing patients to potential shortand long-term complications, such as ICU delirium [7] and subsequent long-term cognitive impairment [8].Although studies of ICU sedation have focused primarily on brain-related outcomes, other organ systems may be affected. Acute kidney injury (AKI) is common in the ICU and is associated with increased length of stay and in-hospital mortality [9]. In this issue of Critical Care, Str£żm and colleagues [1] describe a post hoc analysis of renal outcome data among 103 mechanically ventilated ICU patients enrolled in the authors' previously published trial of 'no sedation' versus a continuous sedation strategy [5]. The authors hypothesized that sedation-induced hypotension would result in more vasopressor use, fluid administration, and AKI among patients in the control group compared with those receiving 'no sedation'.Patients in the 'no sedation' group were managed with morphine as needed for pain and, if necessary, short courses (<6 hours) of sedation with propofol; patients in the control group received continuous propofol infusions with daily interruption. Outcomes included mean arterial pressure, use of vasopressor/inotropic drugs, fluid balance, urine output, and serum creatinine, the latter two being used to classify AKI using the RIFLE (risk, injury, failure, loss, and end-stage renal failure) criteria [10].No difference between groups was observed in mean arterial pressure or amount of vasopressors required, but patients in the 'no sedation' group had greater average urine output during the 14-day period of analysis (1.15 versus 0.88 mL/kg per hour), and this translated to a lower prevalence of AKI (51% versus 76%). The authors thus concl
%U http://ccforum.com/content/15/3/163