Discussion Forum


JOURNAL CLUB - Lung‑protective sedation: moving toward a new paradigm of precision sedation

By: Marcelo Alcantara, Médico - 02/16/2023 06:15

🧐 How to best titrate sedation in severely ill intubated patients?

Elias Baedorf Kassis, Daniel Talmor from Harvard Medical School, and Jeremy R Betieler from Columbia University wrote a very interesting editorial to address this issue.

👉The main message is to shift the paradigm of focusing sedation in ventilated patients to lung and diaphragmatic protection instead of using sedation scales that do not include this very important aspect of respiratory support. 

👉In their words: "...sedation and mechanical ventilation are not dissociable and should be managed together."

👉This new paradigm implicates in development of new references and tools to be applied at the bedside to achieve the goal of a combined approach matching the sedation level to the respiratory goals.

🤔 For instance, we would have to monitor new parameters, such as the amount of respiratory muscle effort and neural drive in a safe range of predefined levels, by titrating the ventilator settings and choosing the most appropriate sedative drug and dose for a specific patient in a specific time.  

👀This novel concept of "Lung Protective Sedation" incorporates several independent but related and synergistic concepts that are summarized in the figure below from the article inline supplement file:


🌐 Check this editorial in the link below.

Kassis EB, Beitler JR, Talmor D. Lung-protective sedation: moving toward a new paradigm of precision sedation. Intensive Care Med. 2023 Jan;49(1):91-94. doi: 10.1007/s00134-022-06901-z.

😉 Or download the PDF file with our remarks highlighting the most important messages in our opinion.

👉 What is your view on this new paradigm? 


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