Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.

Judith Jacobi, PharmD, FCCM, BCPS; Gilles L. Fraser, PharmD, FCCM; Douglas B. Coursin, MD; Richard R. Riker, MD; Dorrie Fontaine, RN, DNSc, FAAN; Eric T. Wittbrodt, PharmD; Donald B. Chalfin, MD, MS, FCCM; Michael F. Masica, MD, MPH; H. Scott Bjerke, MD; William M. Coplin, MD; David W. Crippen, MD, FCCM; Barry D. Fuchs, MD; Ruth M. Kelleher, RN; Paul E. Marik, MDBCh, FCCM; Stanley A. Nasraway, Jr, MD, FCCM; Michael J. Murray, MD, PhD, FCCM; William T. Peruzzi, MD, FCCM; Philip D. Lumb, MB, BS, FCCM. Developed through the Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), in collaboration with the American Society of Health-System Pharmacists (ASHP), and in alliance with the American College of Chest Physicians; and approved by the Board of Regents of ACCM and the Council of SCCM and the ASHP Board of Directors

[1]  T J Gallagher,et al.  Comparison of propofol and midazolam for sedation in intensive care unit patients. , 1995, Critical care medicine.

[2]  R. Millman,et al.  Adverse environmental conditions in the respiratory and medical ICU settings. , 1994, Chest.

[3]  S. Nasraway,et al.  Conduction Disturbances Associated with Administration of Butyrophenone Antipsychotics in the Critically Ill: A Review of the Literature , 1997, Pharmacotherapy.

[4]  J. Walker,et al.  The effect of earplugs on sleep measures during exposure to simulated intensive care unit noise. , 1999, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[5]  J. Still,et al.  Neuroleptic malignant syndrome in a burn patient. , 1998, Burns : journal of the International Society for Burn Injuries.

[6]  D. Schwartz,et al.  Propofol-induced pancreatitis: recurrence of pancreatitis after rechallenge. , 1999, Chest.

[7]  T. Ohwada,et al.  Cardiovascular response and stress reaction to flumazenil injection in patients under infusion with midazolam , 2000, Critical care medicine.

[8]  J. Blumer,et al.  Opioids and other analgesics. Adverse effects in the intensive care unit. , 1991, Critical care clinics.

[9]  L. Dahlgren,et al.  Assessment of postoperative pain: impact of clinical experience and professional role , 1997, Acta anaesthesiologica Scandinavica.

[10]  I. Verma,et al.  CHROMOSOMAL ABERRATIONS IN PROTEIN-CALORIE MALNUTRITION , 1975, The Lancet.

[11]  R. Polomano,et al.  Beyond the Ramsay scale: need for a validated measure of sedating drug efficacy in the intensive care unit. , 1994, Critical care medicine.

[12]  J. Boldt,et al.  Pain management in cardiac surgery patients: comparison between standard therapy and patient-controlled analgesia regimen. , 1998, Journal of cardiothoracic and vascular anesthesia.

[13]  S. Ross,et al.  Lorazepam and midazolam in the intensive care unit: a randomized, prospective, multicenter study of hemodynamics, oxygen transport, efficacy, and cost. , 1996, Critical care medicine.

[14]  Deborah H. Kim Practice Parameters for Intravenous Analgesia and Sedation for Adult Patients in the Intensive Care Unit: An Executive Summary , 1996 .

[15]  S. Reeves,et al.  Continuous infusions of lorazepam, midazolam, and propofol for sedation of the critically ill surgery trauma patient: a prospective, randomized comparison. , 1999, Critical care medicine.

[16]  D. Faigel,et al.  Torsade de pointes complicating the treatment of bleeding esophageal varices: association with neuroleptics, vasopressin, and electrolyte imbalance. , 1995, The American journal of gastroenterology.

[17]  N. Cassem,et al.  Use of high-dose intravenous haloperidol in the treatment of agitated cardiac patients. , 1985, Journal of clinical psychopharmacology.

[18]  C. Spies,et al.  Alcohol withdrawal in the surgical patient: prevention and treatment. , 1999, Anesthesia and analgesia.

[19]  S. Labyak,et al.  The effects of effleurage backrub on the physiological components of relaxation: a meta-analysis. , 1997, Nursing research.

[20]  Carr Db,et al.  Fentanyl infusion and weaning in the pediatric intensive care unit: toward science-based practice. , 1994 .

[21]  M. Carskadon,et al.  Environmental noise as a cause of sleep disruption in an intermediate respiratory care unit. , 1996, Sleep.

[22]  D. W. Newton,et al.  Lorazepam solubility in and sorption from intravenous admixture solutions. , 1983, American journal of hospital pharmacy.

[23]  A. Bodenham,et al.  Midazolam infusions in critically ill patients. , 1991, European journal of anaesthesiology.

[24]  R. Friedman,et al.  Prolongation of the Corrected QT and Torsades de Pointes Cardiac Arrhythmia Associated with Intravenous Haloperidol in the Medically III , 1993, Journal of clinical psychopharmacology.

[25]  A. Kaye,et al.  Herbal medicines: current trends in anesthesiology practice--a hospital survey. , 2000, Journal of clinical anesthesia.

[26]  C. Leier,et al.  The pharmacokinetics of midazolam in patients with congestive heart failure. , 1990, British journal of clinical pharmacology.

[27]  Y. Rasmussen,et al.  Occurrence of withdrawal in critically ill sedated children. , 1999, Critical care medicine.

[28]  P. Silverstone,et al.  Involvement of CYP3A4 and CYP2D6 in the Metabolism of Haloperidol , 1997, Cellular and Molecular Neurobiology.

[29]  A. Asada,et al.  Pain Evaluation in the Intensive Care Unit , 1997, Regional Anesthesia & Pain Medicine.

[30]  A. Donner,et al.  Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit. , 1995, Critical care clinics.

[31]  D. O'Hara,et al.  Pharmacokinetics and Pharmacodynamics of Sedatives and Analgesics in the Treatment of Agitated Critically Ill Patients , 1997, Clinical pharmacokinetics.

[32]  T R Holford,et al.  A multicomponent intervention to prevent delirium in hospitalized older patients. , 1999, The New England journal of medicine.

[33]  R. Ausman,et al.  Analysis of Pain Management in Critically Ill Patients , 1995, Pharmacotherapy.

[34]  Elizabeth Landrum Michalets,et al.  Update: Clinically Significant Cytochrome P‐450 Drug Interactions , 1998, Pharmacotherapy.

[35]  P. Felt-Gunderson,et al.  Diarrhea associated with lorazepam solution in a tube-fed patient. , 1996, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[36]  T. Nishiyama Sedation during Artificial Ventilation by Continuous Intravenous Infusion of Midazolam: Effects of Hepatocellular or Renal Damage , 1997 .

[37]  B. Strom,et al.  Parenteral Ketorolac: The Risk for Acute Renal Failure , 1997, Annals of Internal Medicine.

[38]  V A Feshchenko,et al.  The Comparative Amnestic Effects of Midazolam, Propofol, Thiopental, and Fentanyl at Equisedative Concentrations , 1997, Anesthesiology.

[39]  P. Neuvonen,et al.  Effect of Diltiazem on Midazolam and Alfentanil Disposition in Patients Undergoing Coronary Artery Bypass Grafting , 1996, Anesthesiology.

[40]  M. Jann,et al.  Pharmacokinetics of Haloperidol , 1989, Clinical pharmacokinetics.

[41]  D R Nerenz,et al.  Motor Activity Assessment Scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. , 1999, Critical care medicine.

[42]  T. Vree,et al.  The effects of acute changes in renal function on the pharmacokinetics of midazolam during long-term infusion in ICU patients. , 1991, Acta anaesthesiologica Belgica.

[43]  J. Peterson,et al.  Fentanyl and sufentanil increase intracranial pressure in head trauma patients. , 1992, Anesthesiology.

[44]  M. Barrios,et al.  Comparative study of propofol versus midazolam in the sedation of critically ill patients: results of a prospective, randomized, multicenter trial. , 1996, Critical care medicine.

[45]  D. Stannard,et al.  Relationship between behavioral and physiological indicators of pain, critical care patients' self-reports of pain, and opioid administration. , 1997, Critical care medicine.

[46]  M. Nadal,et al.  Cerebral Hemodynamic Effects of Morphine and Fentanyl in Patients with Severe Head Injury: Absence of Correlation to Cerebral Autoregulation , 2000, Anesthesiology.

[47]  G. Fraser,et al.  Continuous infusion of haloperidol controls agitation in critically ill patients , 1994, Critical care medicine.

[48]  W. Mendelson,et al.  Characteristics and outcomes of patients who self-extubate from ventilatory support: a case-control study. , 1997, Chest.

[49]  D. Glaser,et al.  Pain assessment and management in critically ill postoperative and trauma patients: a multisite study. , 1999, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[50]  G. Fulda,et al.  Neuroleptic malignant syndrome in a trauma patient. , 1995, The Journal of trauma.

[51]  P. O'Gara,et al.  Torsade de pointes caused by high‐dose intravenous haloperidol in cardiac patients , 1995, Clinical cardiology.

[52]  M. Ramsay,et al.  Controlled Sedation with Alphaxalone-Alphadolone , 1974, British medical journal.

[53]  N. Desbiens,et al.  How well do surrogates assess the pain of seriously ill patients? , 2000, Critical care medicine.

[54]  P. Suter,et al.  Pharmacokinetics of midazolam administered by continuous intravenous infusion to intensive care patients , 1992, Critical care medicine.

[55]  J. Takeda,et al.  LIVER BLOOD FLOW DURING HIGH FREQUENCY OSCILLATION AND CONVENTIONAL MECHANICAL VENTILATION , 1984 .

[56]  C. Spies,et al.  Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomized trial. , 1996, Critical care medicine.

[57]  M. M. Hansen,et al.  EFFECT OF STRESS ULCER PROPHYLAXIS ON GASTRIC VOLUME AND BACTERIAL COLONIZATION IN MECHANICALLY VENTILATED, CRITICALLY ILL PATIENTS , 1994 .

[58]  G. Guyatt,et al.  Using and understanding sedation scoring systems: a systematic review , 2000, Intensive Care Medicine.

[59]  I. Koolhoven,et al.  Early diagnosis of delirium after cardiac surgery. , 1996, General hospital psychiatry.

[60]  S. Adams,et al.  Polyethylene Glycol Nephrotoxicity Secondary to Prolonged High-Dose Intravenous Lorazepam , 1995, The Annals of pharmacotherapy.

[61]  S D Kowalski,et al.  A post hoc descriptive study of patients receiving propofol. , 1999, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[62]  L. Zimmerman,et al.  The Effects of Music Interventions on Postoperative Pain and Sleep in Coronary Artery Bypass Graft (CABG) Patients , 1996, Scholarly Inquiry for Nursing Practice.

[63]  B. C. Bloor,et al.  Histamine Release by Four Narcotics: A Double‐Blind Study in Humans , 1987, Anesthesia and analgesia.

[64]  S. McKinley,et al.  Patients' experiences of being in an intensive care unit: a select literature review. , 2000, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[65]  D. Woolston,et al.  Agitation in closed head injury: haloperidol effects on rehabilitation outcome. , 1985, Archives of physical medicine and rehabilitation.

[66]  L. Thijs,et al.  Continuous infusion of lorazepam versus medazolam in patients in the intensive care unit: sedation with lorazepam is easier to manage and is more cost-effective. , 1999, Critical care medicine.

[67]  M. Struys,et al.  Use of continuous bispectral EEG monitoring to assess depth of sedation in ICU patients , 1998, Intensive Care Medicine.

[68]  P. Marik,et al.  Refractory delirium tremens treated with propofol: a case series. , 2000, Critical care medicine.

[69]  G. Larsson,et al.  Pain and distress among elderly intensive care unit patients: comparison of patients' experiences and nurses' assessments. , 1998, Heart & lung : the journal of critical care.

[70]  G. B. Young,et al.  Sleep in critically ill patients requiring mechanical ventilation. , 2000, Chest.

[71]  Melissa R. Johnson,et al.  A Method to Produce Sedation in Critically Ill Patients , 1996, The Annals of pharmacotherapy.

[72]  L. S. Mauro,et al.  Meperidine-related seizures associated with patient-controlled analgesia pumps. , 1993, The Annals of pharmacotherapy.

[73]  C. Kalkman,et al.  Long-term propofol infusion and cardiac failure in adult head-injured patients , 2001, The Lancet.

[74]  D. Lowenthal,et al.  Pharmacokinetic and Pharmacodynamic Changes in the Elderly , 1998, Clinical pharmacokinetics.

[75]  S. Richardson A comparison of tools for the assessment of sleep pattern disturbance in critically ill adults. , 1997, Dimensions of critical care nursing : DCCN.

[76]  D. Schlondorff Renal complications of nonsteroidal anti-inflammatory drugs. , 1993, Kidney international.

[77]  T. Ishizaki,et al.  Pharmacokinetics of Haloperidol , 1999 .

[78]  T. Ishizaki,et al.  Propofol decreases the clearance of midazolam by inhibiting CYP3A4: an in vivo and in vitro study , 1999, Clinical pharmacology and therapeutics.

[79]  Guzzetta Ce,et al.  Effects of relaxation and music therapy on patients in a coronary care unit with presumptive acute myocardial infarction. , 1989 .

[80]  P. Jones,et al.  A cost analysis of alfentanil+propofol vs morphine+midazolam for the sedation of critically ill patients. , 1997, PharmacoEconomics.

[81]  M. Singer,et al.  Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit , 1999, Anaesthesia.

[82]  G Sherman,et al.  Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. , 1999, Critical care medicine.

[83]  E. Sternberg,et al.  The stress response in critical illness. , 1994, New horizons.

[84]  J. Gorski,et al.  The contribution of intestinal and hepatic CYP3A to the interaction between midazolam and clarithromycin , 1998, Clinical pharmacology and therapeutics.

[85]  Propofol and postoperative pancreatitis. , 1996, Anesthesiology.

[86]  R. Arbour Propylene glycol toxicity related to high-dose lorazepam infusion: case report and discussion. , 1999, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[87]  C. Ashton,et al.  Postoperative Delirium: A Review of 80 Primary Data-Collection Studies , 1995 .

[88]  G. Bernard,et al.  Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). , 2001, JAMA.

[89]  G. Fraser,et al.  Frequency, Severity, and Treatment of Agitation in Young versus Elderly Patients in the ICU , 2000, Pharmacotherapy.

[90]  D. Carr,et al.  Fentanyl infusion and weaning in the pediatric intensive care unit: toward science-based practice. , 1994, Critical care medicine.

[91]  J. Kress,et al.  Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. , 2000, The New England journal of medicine.

[92]  A. Parkinson,et al.  Studies on the conversion of haloperidol and its tetrahydropyridine dehydration product to potentially neurotoxic pyridinium metabolites by human liver microsomes. , 1996, Chemical research in toxicology.

[93]  V. Peduto,et al.  Efficacy of propacetamol in the treatment of postoperative pain Morphine‐sparing effect in orthopedic surgery , 1998, Acta anaesthesiologica Scandinavica.

[94]  M. Roizen,et al.  Effects of Low‐Dose Morphine on Gastric Emptying in Healthy Volunteers , 1998, Journal of clinical pharmacology.

[95]  G B Edwards,et al.  Pilot study: validating staff nurses' observations of sleep and wake states among critically ill patients, using polysomnography. , 1993, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[96]  Jin Liu,et al.  Electroencephalographic Bispectral Index Correlates with Intraoperative Recall and Depth of Propofol-Induced Sedation , 1997, Anesthesia and analgesia.

[97]  U. Schnyder,et al.  Early psychological reactions to life‐threatening injuries , 2000, Critical care medicine.

[98]  C. Weissman,et al.  The use of analgesics and sedatives in critically ill patients: physicians' orders versus medications administered. , 1994, Heart & lung : the journal of critical care.

[99]  M. Ferraz,et al.  Stressors in ICU: perception of the patient, relatives and health care team , 1999, Intensive Care Medicine.

[100]  R. Hamill-Ruth,et al.  Evaluation of pain in the critically ill patient. , 1999, Critical care clinics.

[101]  M. Samsom,et al.  Gastrointestinal motility and gastric tube feeding in mechanically ventilated patients. , 1998, Critical care medicine.

[102]  Kathleen M. Moran Acute Pain Management: Operative or Medical Procedures and Trauma. Clinical Practice Guideline. , 1993 .

[103]  C. R. Horsburgh,et al.  Healing by design. , 1995, The New England journal of medicine.

[104]  T. Higgins,et al.  Propofol versus midazolam for intensive care unit sedation after coronary artery bypass grafting , 1994, Critical care medicine.

[105]  Driessen Jj,et al.  The effects of acute changes in renal function on the pharmacokinetics of midazolam during long-term infusion in ICU patients. , 1991 .

[106]  M. Husain,et al.  The Comparative Effects of Methohexital, Propofol, and Etomidate for Electroconvulsive Therapy , 1995, Anesthesia and analgesia.

[107]  J. Kress,et al.  Sedation of critically ill patients during mechanical ventilation. A comparison of propofol and midazolam. , 1996, American journal of respiratory and critical care medicine.

[108]  M. Brodie,et al.  Pharmacokinetics and pharmacodynamics of intravenous midazolam in patients with severe alcoholic cirrhosis. , 1986, Gut.

[109]  W. Browner,et al.  Postoperative Myocardial Ischemia: Therapeutic Trials Using Intensive Analgesia Following Surgery , 1992 .

[110]  Lise,et al.  Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. , 2000, The New England journal of medicine.

[111]  P. V. van Heerden,et al.  Contamination of Propofol Infusions in the Intensive Care Unit: Incidence and Clinical Significance , 1998, Anaesthesia and intensive care.

[112]  P. Updike Music Therapy Results for ICU Patients , 1990, Dimensions of critical care nursing : DCCN.

[113]  M. Frye,et al.  Continuous droperidol infusion for management of agitated delirium in an intensive care unit. , 1995, Psychosomatics.

[114]  D. Chernik,et al.  Validity and Reliability of the Observer's: Assessment of Alertness/Sedation Scale Study with Intravenous Midazolam , 1990, Journal of clinical psychopharmacology.

[115]  A. Cohen,et al.  Propofol-infusion syndrome in children , 1999, The Lancet.

[116]  R. Griffiths,et al.  Disturbed memory and amnesia related to intensive care , 2000, Memory.

[117]  C. Weissman,et al.  Modulating effects of propofol on metabolic and cardiopulmonary responses to stressful intensive care unit procedures. , 1996, Critical care medicine.

[118]  P. Trzepacz,et al.  Motoric subtypes of delirium. , 2000, Seminars in clinical neuropsychiatry.

[119]  J. Spence,et al.  Review of pain-measurement tools. , 1996, Annals of emergency medicine.

[120]  K. Puntillo,et al.  Dimensions of pain and analgesic administration associated with coronary artery bypass grafting in an Australian intensive care unit , 1997 .

[121]  F. Rogers,et al.  Elevated Pancreatic Enzymes after Extended Propofol Therapy , 1998, Pharmacotherapy.

[122]  D. Vernon,et al.  A cost analysis of enterally administered lorazepam in the pediatric intensive care unit. , 1999, Critical care medicine.

[123]  S K Inouye,et al.  Clarifying confusion: the confusion assessment method. A new method for detection of delirium. , 1990, Annals of internal medicine.

[124]  J. Wallin,et al.  Renal failure and hyperkalemia associated with ketorolac tromethamine. , 1993, Archives of internal medicine.

[125]  W. Coplin,et al.  Safety and feasibility of continuous infusion of remifentanil in the neurosurgical intensive care unit. , 2000, Neurosurgery.

[126]  T. Vree,et al.  Decreased plasma albumin concentration results in increased volume of distribution and decreased elimination of midazolam in intensive care patients , 1989, Clinical pharmacology and therapeutics.

[127]  W. Haefeli,et al.  Prolonged sedation due to accumulation of conjugated metabolites of midazolam , 1995, The Lancet.

[128]  R. Mirakhur,et al.  An investigation of the potential morphine sparing effect of midazolam , 1996, Anaesthesia.

[129]  D. O'Hara,et al.  Drugs for amnesia in the ICU. , 1997, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[130]  D. Jenkins,et al.  Substance abuse and withdrawal in the intensive care unit. Contemporary issues. , 2000, The Surgical clinics of North America.

[131]  C. Martin,et al.  Sufentanil, fentanyl, and alfentanil in head trauma patients: a study on cerebral hemodynamics. , 1999, Critical care medicine.

[132]  D. Chittock,et al.  Measuring quality of sedation in adult mechanically ventilated critically ill patients. the Vancouver Interaction and Calmness Scale. Sedation Focus Group. , 2000, Journal of clinical epidemiology.

[133]  Sairam Parthasarathy,et al.  Sleep in the intensive care unit , 2004, Intensive Care Medicine.

[134]  G Sherman,et al.  The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. , 1998, Chest.

[135]  K. Richards Effect of a back massage and relaxation intervention on sleep in critically ill patients. , 1998, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[136]  K. Puntillo Dimensions of procedural pain and its analgesic management in critically ill surgical patients. , 1994, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[137]  R. Schwab,et al.  Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit. , 1999, American journal of respiratory and critical care medicine.

[138]  G. Fraser,et al.  ASSESSING SEDATION LEVELS IN MECHANICALLY VENTILATED ICU PATIENTS WITH THE BISPECTRAL INDEX AND THE SEDATION-AGITATION SCALE , 1998 .

[139]  M. Wallhagen,et al.  Analgesics prescribed and administered to intensive care cardiac surgery patients: does patient age make a difference? , 1996, Progress in cardiovascular nursing.

[140]  J. Dasta,et al.  Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit , 1994, Critical care medicine.

[141]  K. Puntillo,et al.  Dimensions of pain and analgesic administration associated with coronary artery bypass grafting in an Australian intensive care unit. , 1997, Journal of advanced nursing.

[142]  S. Rauch,et al.  Delirium during intra-aortic balloon pump therapy. Incidence and management. , 1992, Psychosomatics.

[143]  F. Konstantinides,et al.  Lorazepam Stability in Parenteral Solutions for Continuous Intravenous Administration , 1996, The Annals of pharmacotherapy.

[144]  R. Narayan,et al.  Propofol in the treatment of moderate and severe head injury: a randomized, prospective double-blinded pilot trial. , 1999, Journal of neurosurgery.

[145]  C. Rosow,et al.  Bispectral index monitoring. , 2001, Anesthesiology clinics of North America.

[146]  M. Carrier,et al.  Propofol or midazolam for sedation and early extubation following cardiac surgery , 1997, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[147]  J. M. White,et al.  Effects of relaxing music on cardiac autonomic balance and anxiety after acute myocardial infarction. , 1999, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[148]  P. Macintyre,et al.  Age is the best predictor of postoperative morphine requirements , 1996, Pain.

[149]  T. Perkins Fentanyl and sufentanil increase intracranial pressure in head trauma patients: Sperry RJ, Bailey PL, Reichman MV et al Anesthesiology 77:416–420 Sep 1992 , 1993 .

[150]  C. Bell DSM-IV: Diagnostic and Statistical Manual of Mental Disorders , 1994 .

[151]  H. Hermesh,et al.  Mortality from neuroleptic malignant syndrome. , 1989, The Journal of clinical psychiatry.

[152]  R. Midha,et al.  Neuroleptic Malignant Syndrome with Intravenous Haloperidol , 1990, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[153]  M. F. Mascia,et al.  Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care , 2000, Critical care medicine.

[154]  Judith E. Hall,et al.  Sedative, Amnestic, and Analgesic Properties of Small-Dose Dexmedetomidine Infusions , 2000, Anesthesia and analgesia.

[155]  E. Alted-López,et al.  Propofol Versus Midazolam: Safety and Efficacy for Sedating the Severe Trauma Patient , 1998, Anesthesia and analgesia.

[156]  L. Chlan,et al.  Effectiveness of a music therapy intervention on relaxation and anxiety for patients receiving ventilatory assistance. , 1998, Heart & lung : the journal of critical care.

[157]  K. Anand,et al.  Pediatric. Tolerance, dependence, and strategies for compassionate withdrawal of analgesics and anxiolytics in the pediatric ICU. , 1996, Critical care nurse.

[158]  J. Dasta,et al.  Sedatives, Analgesics, and Paralytics in the Icu , 1997, The Annals of pharmacotherapy.

[159]  T. Taivainen,et al.  SPREAD OF SPINAL ANAESTHESIA , 1992 .

[160]  C. Sessler,et al.  Validation of a cognitive test for delirium in medical ICU patients. , 1996, Psychosomatics.

[161]  N. Redeker Sleep in acute care settings: an integrative review. , 2000, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[162]  D M Perrotta,et al.  Postoperative infections traced to contamination of an intravenous anesthetic, propofol. , 1995, The New England journal of medicine.

[163]  Paul F. White,et al.  Electroencephalogram bispectral analysis predicts the depth of midazolam-induced sedation. , 1996 .

[164]  K. A. Michael,et al.  Effect of analgesic treatment on the physiological consequences of acute pain. , 1994, American journal of hospital pharmacy.

[165]  J. Tisdale,et al.  Torsades de Pointes associated with intravenous haloperidol in critically ill patients. , 1998, The American journal of cardiology.

[166]  G. Fraser,et al.  Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. , 1999, Critical care medicine.

[167]  S. Kimmel,et al.  Parenteral ketorolac and risk of gastrointestinal and operative site bleeding. A postmarketing surveillance study. , 1997, JAMA.

[168]  D. Stannard,et al.  Clinical judgment and management of postoperative pain in critical care patients. , 1996, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[169]  P. Scragg,et al.  Psychological problems following ICU treatment* , 2001, Anaesthesia.

[170]  S. Myers,et al.  The effects of progressive muscular relaxation on subjectively reported disturbance due to hospital noise. , 1988, Behavioral medicine.

[171]  P. McArdle Intravenous analgesia. , 1999, Critical care clinics.

[172]  H. Kelly,et al.  Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion , 1994, Critical care medicine.

[173]  S. Inouye,et al.  Delirium in the Intensive Care Unit: An Under-Recognized Syndrome of Organ Dysfunction , 2001, Seminars in respiratory and critical care medicine.

[174]  R. Barrientos-Vega,et al.  Prolonged sedation of critically ill patients with midazolam or propofol: impact on weaning and costs. , 1997, Critical care medicine.

[175]  F. Huygen,et al.  Infusion of propofol versus midazolam for sedation in the intensive care unit following coronary artery surgery. , 1993, Journal of cardiothoracic and vascular anesthesia.

[176]  M. Stecker,et al.  Treatment of Refractory Status Epilepticus with Propofol: Clinical and Pharmacokinetic Findings , 1998, Epilepsia.

[177]  C. J. Van der Schyf,et al.  Metabolism of haloperidol to pyridinium species in patients receiving high doses intravenously: is HPTP an intermediate? , 1997, Life sciences.

[178]  W J Sibbald,et al.  Sedation in the intensive care unit: a systematic review. , 2000, JAMA.

[179]  Mark J. Smith,et al.  A critique of instruments and methods to detect, diagnose, and rate delirium. , 1995, Journal of pain and symptom management.

[180]  P. M. Desai,et al.  Pain management and pulmonary dysfunction. , 1999, Critical care clinics.

[181]  F. Breheny Reversal of midazolam sedation with flumazenil , 1992, Critical care medicine.

[182]  Dallace L. Meehan,et al.  Analgesic administration, pain intensity, and patient satisfaction in cardiac surgical patients. , 1995, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[183]  G. Velmahos,et al.  The prevalence and effect of alcohol and drug abuse on cohort-matched critically injured patients. , 1998, The American surgeon.

[184]  G. Fraser,et al.  The Frequency and Cost of Patient‐Initiated Device Removal in the ICU , 2001, Pharmacotherapy.

[185]  S. Nasraway,et al.  Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Society of Critical Care Medicine. , 1995, Critical care medicine.

[186]  D. Greenblatt,et al.  Kinetic and dynamic study of intravenous lorazepam: comparison with intravenous diazepam. , 1989, The Journal of pharmacology and experimental therapeutics.

[187]  A. Pohlman,et al.  Continuous intravenous infusions of lorazepam versus midazolam for sedation during mechanical ventilatory support: A prospective, randomized study , 1994, Critical care medicine.

[188]  P. Trzepacz Delirium. Advances in diagnosis, pathophysiology, and treatment. , 1996, The Psychiatric clinics of North America.

[189]  H. Zimmerman,et al.  Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: Analysis of instances of therapeutic misadventure , 1995, Hepatology.

[190]  T. Stern,et al.  The association between intravenous haloperidol and Torsades de Pointes. Three cases and a literature review. , 1995, Psychosomatics.

[191]  G. Fraser,et al.  Movement disorders associated with withdrawal from high-dose intravenous haloperidol therapy in delirious ICU patients. , 1997, Chest.

[192]  J. S. McDonald,et al.  PROPOSED METHODS FOR PREDICTING DIFFICULT INTUBATION: PROSPECTIVE EVALUATION OF 1501 PATIENTS , 1992 .

[193]  M. Scheinin,et al.  Dexmedetomidine Premedication for Minor Gynecologic Surgery , 1990, Anesthesia and analgesia.

[194]  Stoller Jk,et al.  Healing by Design , 1995 .

[195]  E. Martin,et al.  Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting. , 1999, Critical care medicine.

[196]  C. A. Bolwerk Effects of relaxing music on state anxiety in myocardial infarction patients. , 1990, Critical care nursing quarterly.

[197]  L. Danziger,et al.  Central Nervous System Toxicity Associated With Meperidine Use in Hepatic Disease , 1994, Pharmacotherapy.

[198]  W. Kox,et al.  Clonidine in the treatment of alcohol withdrawal in the intensive care unit. , 1992, British journal of anaesthesia.

[199]  M. Bross,et al.  Delirium in the elderly patient. , 1994, American family physician.

[200]  Y. Skrobik,et al.  Intensive Care Delirium Screening Checklist: evaluation of a new screening tool , 2001, Intensive Care Medicine.

[201]  W. Breitbart,et al.  A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. , 1996, The American journal of psychiatry.

[202]  C. Sessler,et al.  Abbreviated cognitive test for delirium. , 1997, Journal of psychosomatic research.

[203]  D. Smith,et al.  Haemodynamic responses to extubation after cardiac surgery with and without continued sedation. , 1998, British journal of anaesthesia.

[204]  G N Kenny,et al.  Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index. , 1997, British journal of anaesthesia.

[205]  M. W. Tsang,et al.  Metabolism of haloperidol: clinical implications and unanswered questions. , 1994, Journal of clinical psychopharmacology.

[206]  T. Blaschke,et al.  Morphine‐induced venodilation in humans , 1996, Clinical pharmacology and therapeutics.

[207]  D. Moher,et al.  Propofol vs midazolam for ICU sedation : a Canadian multicenter randomized trial. , 2001, Chest.

[208]  S. Mewaldt,et al.  Benzodiazepines and Human Memory: A Review , 1990, Anesthesiology.

[209]  J. Sánchez-Izquierdo Riera,et al.  Midazolam and 2% propofol in long-term sedation of traumatized critically ill patients: efficacy and safety comparison. , 2000, Critical care medicine.

[210]  J. Wilt,et al.  Torsade de Pointes Associated with the Use of Intravenous Haloperidol , 1993, Annals of Internal Medicine.

[211]  G. Bailie,et al.  Pharmacokinetics of propofol during and after long-term continuous infusion for maintenance of sedation in ICU patients. , 1992, British journal of anaesthesia.

[212]  T. Staudinger,et al.  No reduction in the sufentanil requirement of elderly patients undergoing ventilatory support in the medical intensive care unit. , 1999, European journal of anaesthesiology.

[213]  J F Byers,et al.  Effect of a music intervention on noise annoyance, heart rate, and blood pressure in cardiac surgery patients. , 1997, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[214]  J S Hammond,et al.  Patient Recall of Therapeutic Paralysis in a Surgical Critical Care Unit , 1998, Pharmacotherapy.

[215]  K. Aronson,et al.  Comparison of sedative recovery time after midazolam versus diazepam administration , 1994, Critical care medicine.

[216]  Theodore Speroff,et al.  Evaluation of delirium in critically ill patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) , 2001, Critical care medicine.

[217]  Thomas E. Elliott,et al.  Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 4th Edition:The American Pain Society: Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain. 4th edition. , 2000 .

[218]  M. Wilkin,et al.  Comment: Possible Toxicity from Propylene Glycol in Lorazepam Infusion , 1997, The Annals of pharmacotherapy.

[219]  Philip D Lumb,et al.  Sedation, analgesia, and neuromuscular blockade of the critically ill adult: revised clinical practice guidelines for 2002. , 2002, Critical care medicine.

[220]  A. Wu,et al.  Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations. For the SUPPORT investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatmentm. , 1996, Critical care medicine.

[221]  B. C. Bloor,et al.  Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. , 1992, Anesthesiology.

[222]  Mateo Om,et al.  A pilot study to assess the relationship between behavioral manifestations and self-report of pain in postanesthesia care unit patients. , 1992 .

[223]  D. Eyles,et al.  Quantitative analysis of two pyridinium metabolites of haloperidol in patients with schizophrenia , 1994, Clinical pharmacology and therapeutics.

[224]  G. Carrasco,et al.  Propofol vs midazolam in short-, medium-, and long-term sedation of critically ill patients. A cost-benefit analysis. , 1993, Chest.

[225]  D. Greenblatt,et al.  Effect of Age, Gender, and Obesity on Midazolam Kinetics , 1984, Anesthesiology.

[226]  G. Fraser,et al.  Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale. , 1999, Critical care medicine.

[227]  M. Breslow,et al.  Catecholamine and cortisol responses to lower extremity revascularization: correlation with outcome variables. Perioperative Ischemia Randomized Anesthesia Trial Study Group. , 1995, Critical care medicine.

[228]  M. Bullinger,et al.  Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. , 1998, Critical care medicine.

[229]  J. Pittet,et al.  Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients. , 1998, Critical care medicine.

[230]  J. Blumer,et al.  Assessing distress in pediatric intensive care environments: the COMFORT scale. , 1992, Journal of pediatric psychology.

[231]  M. Seneff,et al.  Use of Haloperidol Infusions to Control Delirium in Critically Ill Adults , 1995, The Annals of pharmacotherapy.

[232]  G. Fraser,et al.  Validating the Sedation-Agitation Scale with the Bispectral Index and Visual Analog Scale in adult ICU patients after cardiac surgery , 2001, Intensive Care Medicine.

[233]  A. Aitkenhead,et al.  COMPARISON OF PROPOFOL AND MIDAZOLAM FOR SEDATION IN CRITICALLY ILL PATIENTS , 1989, The Lancet.

[234]  T. Zaroda,et al.  Improving pain management in critical care. , 1996, The Joint Commission journal on quality improvement.

[235]  G. Carrasco,et al.  Synergistic sedation with propofol and midazolam in intensive care patients after coronary artery bypass grafting. , 1998, Critical care medicine.

[236]  F. Colardyn,et al.  Effect of propofol on elevated intracranial pressure. Preliminary results , 1988, Anaesthesia.

[237]  J. Tobias,et al.  Subcutaneous administration of fentanyl and midazolam to prevent withdrawal after prolonged sedation in children. , 1999, Critical care medicine.

[238]  T. Stern,et al.  Analytic Reviews : Rapid Tranquilization of the Agitated Intensive Care Unit Patient , 1988 .

[239]  R. Griffiths,et al.  Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care , 2001, Critical care medicine.