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A new University study has found that there is no national consensus on the type and amount of sedatives administered to medical intensive care unit patients with respiratory failure. Sedatives are commonly administered to make ICU patients feel more comfortable when they are receiving mechanical respiration through a tracheal tube. "Essentially we found that sedatives are given to almost everyone receiving mechanical ventillation in the event of respiratory failure," said Carole Basile, HUP research study coordinator with the pulmonary department. Despite the widespread use of sedatives at ICUs nationwide, there is no commonly accepted rule for the amount of medication employed, the method of administering the drug, or the time period during which the patient may safely remain unconscious. "We found variation across the board in all areas of sedation," Basile said. According to the study, 17 different sedating drugs are used by ICUs nationwide. The drugs are often used to induce paralysis to prevent the patient from moving and interfering with the mechanical respiration. "Otherwise the ventillator isn't well tolerated [by the patient]," Hansen-Flaschen said. Hansen-Flaschen said researchers now need to study the sedatives' effect on patients while they are unconscious. "I think it's a pretty bizarre thing that's happpening that no one knows much about," Hansen-Flaschen said. Frequently patients remain partially conscious when they do not receive enough anesthetic, an eperience he described as being in a "Rip Van Winkle state." "You go in Tuesday and then you wake up three weeks and five days later and you have crazy nighmarish memories of the whole thing," Hansen-Flaschen said. "A month ago we identified a patient who was unconscious for 36 hours, but she remembered the experience." The results of the study are based on a survey which was sent to 265 U.S. medical ICUs which train pulmonary fellows. 164 hospitals -- 62 percent of those surveyed -- responded to questions about their use of sedatives and neuromuscular blockers. "We got the idea for the study when we were introducing a new sedative at our ICU and we realized that not much research had been done on this subject," Basile said. The article appeared in the November 27 issue of the Journal of the American Medical Association.

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