HHE Emergency care supplement 2018 - Page 12

and enhance arousability and the patient’s ability to communicate with caregivers. Dexmedetomidine may reduce delirium after long-term sedation as compared with midazolam, 50 and also reduce the overall neurocognitive adverse events of sedation, such as agitation, anxiety, and delirium, compared with propofol. 51 However, safety and efficacy of this drug have not been evaluated in some ICU patient groups, such as patients with acute neurologic disorder (for example, stroke and head trauma). 2 Newer alternatives Inhalative sedation in the ICU is starting to spread all over Europe and has been recommended as an alternative in a German consensus guideline. 52 The device ΥΝ•₯́…±±•Ή… ½Ή„€‘Ή…•ΝΡ‘•Ρ₯Œ) ½ΉΝ•ΙΩ₯Ήœ•Ω₯”€°έ‘₯ ΅…­•ΜΑ½ΝΝ₯‰±”Ρ‘”)…‘΅₯Ή₯ΝΡΙ…Ρ₯½Έ½˜…Ή…•ΝΡ‘•Ρ₯Œ…•ΉΡΜ€‘₯Ν½™±ΥΙ…Ή”)…ΉΝ•Ω½™±ΥΙ…Ή”€₯Έ…ΉδΩ•ΉΡ₯±…ѽȁ½΅΅½Ή±δ)™½ΥΉ₯ΈΡ‘”% TΈ€ΤϊLΤΤ)%Ν½™±ΥΙ…Ή”°Ν•Ω½™±ΥΙ…Ή”…Ή‘•Ν™±ΥΙ…Ή”‘…Ω”)Ν‘½έΈΝ½΅”‰•Ή•™₯Ρ́½΅Α…Ι•έ₯Ρ ₯ΉΡΙ…Ω•Ή½ΥΜ)Ν•‘…Ρ₯½ΈΈQ‘•δ‘…Ω”„±½ά΅•Ρ…‰½±₯Ν΄…Ή°‘Υ”)ΡΌΡ‘•₯ȁ±½άΝ½±Υ‰₯±₯Ρ䰁…Ι”•±₯΅₯Ή…Ρ•ΕΥ₯­±δ)…Ή½™™•ΜΝ‘½Ιѕȁ…Ή΅½Ι”ΑΙ•‘₯Ρ…‰±”έ…­”΅Υΐ)Ρ₯΅•ΜΡ‘…Έ₯ΉΡΙ…Ω•Ή½Ύ…•ΉΡΜΈ€ΤΠ΄ΤΰQ‘•δ…Έ…±ΝΌ)ΑΙ•Ω•ΉΠΡ‘”‘•Ω•±½Α΅•ΉΠ½˜‰Ι½Ή‘½ΝΑ…΄°€ΤΜ°ΤΤ)‘…Ω”…Ι‘₯½ΑΙ½Ρ•Ρ₯Ω”•™™•ΡΜ€ΤЁ…Ή…Ι”)‘…•΅½‘εΉ…΅₯…±±δ΅½Ι”ΝΡ…‰±”Ρ‘…Έ₯ΉΡΙ…Ω•Ή½ΥΜ)‘Ι՝̸€ΤΤ)M½΅”Ω½±…Ρ₯±”…Ή•ΝΡ‘•Ρ₯Μ…‰½±₯Ν •Ι•‰Ι…°)…ΥΡ½Ι•Υ±…Ρ₯½Έ…Ё‘₯ ‘½Ν•Μμ₯Ё‘…́‰••ΈΙ•Α½ΙΡ•)Ρ‘…Ё…Π€ΔΈΐ5 Ν•Ω½™±ΥΙ…Ή”°Ρ‘”…ΥΡ½Ι•Υ±…Ρ₯½Έ½˜)•Ι•‰Ι…°‰±½½™±½άΙ•΅…₯Ή•₯ΉΡ…Π°‰ΥЁё…Ёё₯Μ)݅́₯΅Α…₯Ι•…Π€ΘΈΐ5 ΈQ‘•δ…±ΝΌ‘…Ω”„‘₯Ι•Π)Ή•ΥΙ½ΑΙ½Ρ•Ρ₯Ω”•™™•Π₯ΈΑ•Ι₯½‘́½˜₯ΈΩ₯ΡΙΌ€Τ䁅Ή)₯ΈΩ₯ΩΌ€Ψΐ₯͍‘…•΅₯„½Θ…‘΅₯Ή₯ΝΡ•Ι•ΑΙ₯½ΘΡΌ₯Π(‘…Ή…•ΝΡ‘•Ρ₯Œ½Ή‘₯Ρ₯½Ή₯Ήœ€Έ€ΨāAΙ•½Ή‘₯Ρ₯½Ή₯Ήœ‘…Μ)‰••Έ‘•ΝΙ₯‰•₯Έ₯ΈΩ₯ΡΙΌ€Ψȁ…Ή₯ΈΩ₯ΩΌ€Ψ́΅½‘•±Μ½˜)•Ι•‰Ι…°₯͍‘…•΅₯„ΈM•Ω½Ι…Ή”…±ΝΌ‘…́„Ι½±”₯Έ)Α½ΝΠ΅½Ή‘₯Ρ₯½Ή₯Ήœμ₯Ρ́…ΑΑ±₯…Ρ₯½Έ½Υ±‰”½˜)₯ΉΡ•Ι•ΝЁ½Ή”•Ι•‰Ι…°₯͍‘…•΅₯„‘…́½ΥΙΙ•Έ)1•”•Π…°€ΨЁ™½ΥΉΡ‘…Ё₯Ν½™±ΥΙ…Ή”Α½ΝΠ΅½Ή‘₯Ρ₯½Ή₯Ήœ)Ι•‘Ս•‰Ι…₯Έ₯Ή©ΥΙ䁑ՔΡΌ₯͍‘…•΅₯„₯ΈΙ…ΡΜΈ)!½έ•Ω•Θ°…Π€ΐΈΤ5 °…‘•ΕΥ…Ρ”Ή•ΥΙ½ΑΙ½Ρ•Ρ₯½Έ)₯́Ή½Π½‰Ρ…₯Ή•°έ‘₯ ΅•…ΉΜΡ‘…Ёё”•™™•Π½˜)Ν•Ω½™±ΥΙ…Ή”Α½ΝΠ΅½Ή‘₯Ρ₯½Ή₯Ήœ₯Έ™½…°₯͍‘…•΅₯Œ)±•ΝΝ₯½ΉΜ₯́‘½Ν”΅‘•Α•Ή‘•ΉΠΈ€ΨΤ)%Έ„ΑΙ½ΝΑ•Ρ₯Ω”ΝΡՑ䁽˜Ν•Ω½™±ΥΙ…Ή”Ν•‘…Ρ₯½Έ)₯ΈΑ…Ρ₯•ΉΡ́έ₯Ρ …ΥΡ”ΝΡΙ½­”½ΘΝΥ‰…Ι…‘Ή½₯)‘…•΅½ΙΙ‘…”°ΝΥ™™₯₯•ΉΠΝ•‘…Ρ₯½Έ±•Ω•±Μέ₯Ρ‘½ΥΠ)±₯Ή₯…±±δΙ•±•Ω…ΉΠ% @₯ΉΙ•…͕́ݕɔ…‘₯•Ω•₯Έ(Ψΰ”½˜Α…Ρ₯•ΉΡΜΈ€Ψ؁!½έ•Ω•Θ°Ν•Ι₯½Ύ…‘Ω•ΙΝ”•Ω•ΉΡΜ)½‰Ν•ΙΩ•₯ΈΡ‘”Ι•΅…₯Ή₯Ήœ€ΜΘ”Ι…₯Ν”½ΉΝ₯‘•Ι…‰±”)Ν…™•Ρ䁍½Ή•ΙΉΜΈ5•…Έ…ΙΡ•Ι₯…°ΑΙ•ΝΝΥΙ”€‘5@€)‘…ΡΌ‰”ΝΡ…‰₯±₯Ν•…Ρ₯Ω•±δΡΌ΅…₯ΉΡ…₯Έ A@Έ) …Ν•½ΈΡ‘•Ν”½‰Ν•ΙΩ…Ρ₯½ΉΜ°₯Ё݅́½Ή±Υ‘•)Ρ‘…Ёё…Ёё”…±±••Ή•ΥΙ½ΑΙ½Ρ•Ρ₯Ω”Α½Ρ•ΉΡ₯…°½˜)Ν•Ω½™±ΥΙ…Ή”‘ΌΉ½Π½ΥΡέ•₯‘́ё”Ι₯Ν¬½˜…‘Ω•ΙΝ”)•Ω•ΉΡ́…ΉΝ•Ω½™±ΥΙ…Ή”Ν•‘…Ρ₯½ΈΝ‘½Υ±ΑΙ½‰…‰±δ)Ή½Π‰”ΥΝ•₯ΈΡ‘₯́ΝΑ•₯™₯ŒΑ…Ρ₯•ΉΠΑ½ΑΥ±…Ρ₯½ΈΈ€ΨΨ)Y½±…Ρ₯±”Ν•‘…Ρ₯½Έ‘…́‘₯ΝΡ½Ι₯…±±δ‰••Έ)½ΉΝ₯‘•Ι•ΥΉΝ…™”₯ΈΉ•ΥΙ½Ι₯Ρ₯…°…Ι”ΥΉ₯ΡΜ)…Ι½ΥΉΡ‘”έ½Ι±Έ!½έ•Ω•Θ°…́ΑΙ•Ω₯½ΥΝ±δ)΅•ΉΡ₯½Ή•…ΉΝ՝•ΝΡ•₯ΈΝ•Ω•Ι…°ΝΡΥ‘₯•Μ°Ρ‘”)Α½Ρ•ΉΡ₯…°Ή•ΥΙ½ΑΙ½Ρ•Ρ₯Ω”‰•Ή•™₯Ё½˜₯Ή‘…±…Ρ₯Ω”)Ν•‘…Ρ₯½Έ‘…́Ѽ‰”΅½Ι”ΝΡΥ‘₯•Έ)́ݕ±°…́₯Ή‘…±…Ρ₯Ω”Ν•‘…Ρ₯Ω•Μ°Ρ‘”ΥΝ”½˜)­•Ρ…΅₯Ή”‘…́…±ΝΌ‰••Έ‘•‰…Ρ•‰•…ΥΝ”½˜Ρ‘”(ΔΘ)!!€ΘΐΔΰπ‘½ΝΑ₯Ρ…±‘•…±Ρ‘…Ι”Ή½΄)½Ή•ΙΈΙ…₯Ν•‰δ•…Ι±δΝΡΥ‘₯•ΜΡ‘…Ё₯Ё݅Μ)…ΝΝ½₯…Ρ•έ₯Ρ ₯ΉΙ•…Ν•% @Έ€Ψ܁%ΈΝΡΥ‘₯•Μ)•α…΅₯Ή₯ΉœΡ‘”•Ι•‰Ι…°‘…•΅½‘εΉ…΅₯Œ•™™•ΡΜ)½˜­•Ρ…΅₯Ή”…™Ρ•Θ…ΥΡ”‰Ι…₯Έ₯Ή©ΥΙ䰁% @έ…Μ)Ι•‘Ս•…Ή A@Ι•΅…₯Ή•ΝΡ…‰±”½Θ₯ΉΙ•…Ν•°)έ₯Ρ‘½ΥЁΝ₯Ή₯™₯…ΉΠ‘…Ή•Μ₯Έ•Ι•‰Ι…°)‘…•΅½‘εΉ…΅₯ΜΈ€ΨΰΝεΝΡ•΅…Ρ₯ŒΙ•Ω₯•ά½Ή±Υ‘•)Ρ‘…Ё­•Ρ…΅₯Ή”έ…́Ή½Π…ΝΝ½₯…Ρ•έ₯Ρ …Έ)₯ΉΙ•…Ν•Ι₯Ν¬½˜% @•±•Ω…Ρ₯½Έ°…́ͅ₯)ΑΙ•Ω₯½ΥΝ±δΈ€Ψδ)-•Ρ…΅₯Ή”₯́„Ν‘½ΙΠ΅…Ρ₯Ήœ95Ι••ΑΡ½Θ)…ΉΡ…½Ή₯ΝЁέ₯Ρ „Ι…Α₯½ΉΝ•Π½˜…Ρ₯½ΈΈ%Ё‘½•Μ)Ή½Π…±Ρ•ΘΝεΝΡ•΅₯Œ‘…•΅½‘εΉ…΅₯Μ½ΘΙ•ΝΑ₯Ι…Ρ½Ιδ)‘Ι₯Ω”°Ρ‘•Ι•™½Ι”₯Ё…Έ‰”ΥΝ•₯ΈΉ½Έ΅₯ΉΡΥ‰…Ρ•)Α…Ρ₯•ΉΡΜΈЁ‘½Ν•Μ½˜€ΗŠLΥ΅œ½­œ½‘½ΥΘ°₯Ё…Έ‰”)ΥΝ•…́…Έ…‘©ΥΉΠΡΌ½Ρ‘•ΘΝ•‘…Ρ₯ٕ́Ѽ₯΅ΑΙ½Ω”)Ρ‘•₯ȁ•™™•Ρ́…ΉΡ‘Ύ±₯΅₯Ё‘Ι՜Ι•ΕΥ₯Ι•΅•ΉΡΜΈ) ½Ή±ΥΝ₯½ΉΜ)M•‘…Ρ₯½Έ…Ή…Ή…±•Ν₯„₯́™Ι•ΕΥ•ΉΡ±δΥΝ•₯Έ)Ρ‘”΅…Ή…•΅•ΉΠ½˜Ι₯Ρ₯…±±δ₯±°Α…Ρ₯•ΉΡ́…Ή₯Μ)Ι•±…Ρ•ΡΌ„±½Ή•Θ‘½ΝΑ₯Ρ…°Νх䁅Ή΅½Ι”)‘₯™™₯Υ±Πέ•…Ή₯Ήœ™Ι½΄΅•‘…Ή₯…°Ω•ΉΡ₯±…Ρ₯½ΈΈ)!½έ•Ω•Θ°₯ΈΉ•ΥΙ½₯ΉΡ•ΉΝ₯Ω”…Ι”ΥΉ₯ΡΜ°₯Ё₯́…±ΝΌ)„Ρ‘•Ι…Α•ΥΡ₯ŒΝΡΙ…Ρ•δΈQ‘•Ι•™½Ι”ΝΡΥ‘₯•Μ‘…Ω”)‰••Έ‘•Ω•±½Α•ΡΌ…‘₯•Ω”•™™₯₯•ΉΠΝ•‘…Ρ₯½Έ…Ή)…Ω½₯Ρ‘”…‘Ω•ΙΝ”•™™•Ρ́…́΅Υ …́Α½ΝΝ₯‰±”Έ)5₯‘…ι½±…΄…ΉΑΙ½Α½™½°…Ι”Ρ‘”΅½ΝΠ)™Ι•ΕΥ•ΉΡ±δΥΝ•™₯ΙΝΠ΅±₯Ή”Ν•‘…Ρ₯Ω•Μ쁑½έ•Ω•Θ°)ΥΝ”½˜‰•Ήι½‘₯…ι•Α₯Ή•Μ₯́±•Ν́½΅΅½Έ‰•…ΥΝ”)½˜Ρ‘•₯ȁ‘•±•Ρ•Ι₯½Ύ•™™•ΡΜ°ΝՍ …́ΑΙ½±½Ή₯Ήœ)΅•‘…Ή₯…°Ω•ΉΡ₯±…Ρ₯½ΈΡ₯΅”…Ή₯ΉΙ•…Ν₯Ήœ)…έ…­•Ή₯ΉœΡ₯΅•ΜΈ)9•άΡΙ•Ή‘Μ°ΝՍ …́₯Ή‘…±…Ρ₯Ω”Ν•‘…Ρ₯½Έ½Θ)­•Ρ…΅₯Ή”°…Ι”‰•₯ΉΉ₯ΉœΡΌ…ΙΉ•Θ΅½Ι”)…ΡΡ•ΉΡ₯½Έ°‰ΥЁ΅½Ι”ΝΡΥ‘₯•Μ…Ι”Ι•ΕΥ₯Ι•ΡΌ™Υ±±δ)½Ή™₯Ι΄Ρ‘•₯ȁΥΝ”Έ