rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2012-3-56rmt-222Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSСедация в интенсивной терапии. Обзор современного состояния проблемыSedation in Intensive Care: A review of the State-of-the-ArtБелышевС. Ю.BelyshevS. Yu.belyshev.su@mail.ruЛевитА. Л.LevitA. L.-20122006201283Том VIII № 3 2012 г.5656Copyright © Белышев С.Ю., Левит А.Л., 20122012Белышев С.Ю., Левит А.Л.Belyshev S.Y., Levit A.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/222

Обзор посвящен проблеме седации пациентов в отделении реанимации и интенсивной терапии. Освещены вопросы мониторинга, выбора целевого уровня седации, применения паузы седации, а также современный выбор препаратов. Ключевые слова: седация в ОРИТ, шкала седации, пауза седации, протокол седации, целевой уровень седации.

The review deals with sedation in intensive care unit patients. It covers problems in monitoring, choice of a goal sedation level, use of a sedation pause and timely choice of medications. Key words: intensive care unit sedation, sedation scale, sedation pause, goal sedation level.

ReferencesHollis D. A.Hollis D. A.Ramsay M. A., Savege T. M., Simpson B. R., Goodwin R.Controlled sedation with alphaxalone-alphadolone. Br. Med. J. 1974; 2 (5920): 656—659.Ramsay M. A., Savege T. M., Simpson B. R., Goodwin R.Controlled sedation with alphaxalone-alphadolone. Br. Med. J. 1974; 2 (5920): 656—659.Kress J. P., Pohlman A. S., O’Connor M. F., Hall J. B.Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N. Engl. J. Med. 2000; 342 (20): 1471—1477.Kress J. P., Pohlman A. S., O’Connor M. F., Hall J. B.Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N. Engl. J. Med. 2000; 342 (20): 1471—1477.Hogarth D. K., Hall J.Management of sedation in mechanically ventilated patients. Curr. Opin. Crit. Care 2004; 10 (1): 40—46.Hogarth D. K., Hall J.Management of sedation in mechanically ventilated patients. Curr. Opin. Crit. Care 2004; 10 (1): 40—46.Robinson B. R., Mueller E. W., Henson K. et al.An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J. Trauma 2008; 65 (3): 517—526.Robinson B. R., Mueller E. W., Henson K. et al.An analgesia-delirium-sedation protocol for critically ill trauma patients reduces ventilator days and hospital length of stay. J. Trauma 2008; 65 (3): 517—526.Kollef M. H., Levy N. T., Ahrens T. S. et al.The use of continuous i. v sedation is associated with prolongation of mechanical ventilation. Chest. 1998; 114 (2): 541—548.Kollef M. H., Levy N. T., Ahrens T. S. et al.The use of continuous i. v sedation is associated with prolongation of mechanical ventilation. Chest. 1998; 114 (2): 541—548.Kramer A. A., Zimmerman J. E.A predictive model for the early identification of patients at risk for a prolonged intensive care unit length of stay. BMC Med. Inform. Decis. Mak. 2010; 10: 2Kramer A. A., Zimmerman J. E.A predictive model for the early identification of patients at risk for a prolonged intensive care unit length of stay. BMC Med. Inform. Decis. Mak. 2010; 10: 2Jacobi J, Fraser G. L., Coursin D. B. et al.Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit. Care Med. 2002; 30 (1): 119—141.Jacobi J, Fraser G. L., Coursin D. B. et al.Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit. Care Med. 2002; 30 (1): 119—141.Sessler C. N., Varney K.Patient-focused sedation and analgesia in the ICU. Chest 2008; 133 (2): 552—565.Sessler C. N., Varney K.Patient-focused sedation and analgesia in the ICU. Chest 2008; 133 (2): 552—565.Riker R. R., Fraser G. L.Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit. Pharmacotherapy 2005; 25 (5 Pt 2): 8S—18S.Riker R. R., Fraser G. L.Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit. Pharmacotherapy 2005; 25 (5 Pt 2): 8S—18S.Pandharipande P., Shintani A., Peterson J. et al.Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006; 104 (1): 21—26.Pandharipande P., Shintani A., Peterson J. et al.Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006; 104 (1): 21—26.Ely E. W., Shintani A., Truman B. et al.Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004; 291 (14): 1753—1762.Ely E. W., Shintani A., Truman B. et al.Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004; 291 (14): 1753—1762.Ostermann M. E., Keenan S. P., SeiferlingR. A., Sibbald W.J.Sedation in the intensive care unit: a systematic review. JAMA 2000; 283 (11): 1451—1459.Ostermann M. E., Keenan S. P., SeiferlingR. A., Sibbald W.J.Sedation in the intensive care unit: a systematic review. JAMA 2000; 283 (11): 1451—1459.Rello J, Diaz E., Roque M., VallesJ.Risk factors for developing pneumonia within 48 hours of intubation. Am. J. Respir. Crit. Care Med. 1999; 159 (6): 1742—1746.Rello J, Diaz E., Roque M., VallesJ.Risk factors for developing pneumonia within 48 hours of intubation. Am. J. Respir. Crit. Care Med. 1999; 159 (6): 1742—1746.Nseir S., Makris D., Mathieu D. et al.Intensive Care Unit-acquired infection as a side effect of sedation. Crit. Care 2010; 14 (2): R30.Nseir S., Makris D., Mathieu D. et al.Intensive Care Unit-acquired infection as a side effect of sedation. Crit. Care 2010; 14 (2): R30.Arroliga A., Frutos-Vivar F., Hall J. et al.Use of sedatives and neuromus-cular blockade in a cohort of patients receiving mechanical ventilation. Chest 2005; 128 (2): 496—506.Arroliga A., Frutos-Vivar F., Hall J. et al.Use of sedatives and neuromus-cular blockade in a cohort of patients receiving mechanical ventilation. Chest 2005; 128 (2): 496—506.Kress J. P., Pohlman A. S., Hall J. B.Sedation and analgesia in the intensive care unit. Am. J. Respir. Crit. Care Med. 2002; 166 (8): 1024—1028.Kress J. P., Pohlman A. S., Hall J. B.Sedation and analgesia in the intensive care unit. Am. J. Respir. Crit. Care Med. 2002; 166 (8): 1024—1028.Malacrida R., Fritz M. E., Suter P. M., Crevoisier C.Pharmacokinetics of midazolam administered by continuous intravenous infusion to intensive care patients. Crit. Care Med. 1992; 20 (8): 1123—1126.Malacrida R., Fritz M. E., Suter P. M., Crevoisier C.Pharmacokinetics of midazolam administered by continuous intravenous infusion to intensive care patients. Crit. Care Med. 1992; 20 (8): 1123—1126.Szumita P. M., Baroletti S. A., Anger K. E., Wechsler M. E.Sedation and analgesia in the intensive care unit: evaluating the role of dexmedeto-midine. Am. J. Health Syst. Pharm. 2007; 64 (1): 37—44.Szumita P. M., Baroletti S. A., Anger K. E., Wechsler M. E.Sedation and analgesia in the intensive care unit: evaluating the role of dexmedeto-midine. Am. J. Health Syst. Pharm. 2007; 64 (1): 37—44.Reschreiter H., Maiden M., Kapila A.Sedation practice in the intensive care unit: a UK national survey. Crit. Care. 2008; 12 (6): R152.Reschreiter H., Maiden M., Kapila A.Sedation practice in the intensive care unit: a UK national survey. Crit. Care. 2008; 12 (6): R152.Strom T., Johansen R. R., Prahl J. O., Toft P.Sedation and renal impairment in critically ill patients: a post hoc analysis of a randomized trial. Crit. Care. 2011; 15 (3): R119.Strom T., Johansen R. R., Prahl J. O., Toft P.Sedation and renal impairment in critically ill patients: a post hoc analysis of a randomized trial. Crit. Care. 2011; 15 (3): R119.Pratico C., Quattrone D., Lucanto T. et al.Drugs of anesthesia acting on central cholinergic system may cause post-operative cognitive dysfunction and delirium. Med. Hypotheses 2005; 65 (5): 972—982.Pratico C., Quattrone D., Lucanto T. et al.Drugs of anesthesia acting on central cholinergic system may cause post-operative cognitive dysfunction and delirium. Med. Hypotheses 2005; 65 (5): 972—982.Mulsant B. H., Pollock B. G., Kirshner M. et al.Serum anticholinergic activity in a community-based sample of older adults: relationship with cognitive performance. Arch. Gen. Psychiatry. 2003; 60 (2): 198—203.Mulsant B. H., Pollock B. G., Kirshner M. et al.Serum anticholinergic activity in a community-based sample of older adults: relationship with cognitive performance. Arch. Gen. Psychiatry. 2003; 60 (2): 198—203.Carnahan R. M., Lund B. C., Perry P. J., Pollock B. G.A critical appraisal of the utility of the serum anticholinergic activity assay in research and clinical practice. Psychopharmacol. Bull. 2002; 36 (2): 24—39.Carnahan R. M., Lund B. C., Perry P. J., Pollock B. G.A critical appraisal of the utility of the serum anticholinergic activity assay in research and clinical practice. Psychopharmacol. Bull. 2002; 36 (2): 24—39.Ancelin M. L., de Roquefeuil G., Ledesert B. et al.Exposure to anaesthetic agents, cognitive functioning and depressive symptomatology in the elderly. Br. J. Psychiatry. 2001; 178: 360—366.Ancelin M. L., de Roquefeuil G., Ledesert B. et al.Exposure to anaesthetic agents, cognitive functioning and depressive symptomatology in the elderly. Br. J. Psychiatry. 2001; 178: 360—366.Dodds C., Allison J.Postoperative cognitive deficit in the elderly surgical patient. Br. J. Anaesth. 1998; 81 (3): 449—462.Dodds C., Allison J.Postoperative cognitive deficit in the elderly surgical patient. Br. J. Anaesth. 1998; 81 (3): 449—462.Gaudreau J. D., Gagnon P., Roy M. A. et al.Association between psy-choactive medications and delirium in hospitalized patients: a critical review. Psychosomatics 2005; 46 (4): 302—316.Gaudreau J. D., Gagnon P., Roy M. A. et al.Association between psy-choactive medications and delirium in hospitalized patients: a critical review. Psychosomatics 2005; 46 (4): 302—316.Pandharipande P., Ely E. W.Sedative and analgesic medications: risk factors for delirium and sleep disturbances in the critically ill. Crit. Care Clin. 2006; 22 (2): 313—327, vii.Pandharipande P., Ely E. W.Sedative and analgesic medications: risk factors for delirium and sleep disturbances in the critically ill. Crit. Care Clin. 2006; 22 (2): 313—327, vii.Тимербаев В. Х., Генов П. Г., Лесник В. Ю.Проблема обезболивания в торакальной хирургии и пути решения. Общая реаниматология 2011; VII (5): 46—56.Тимербаев В. Х., Генов П. Г., Лесник В. Ю.Проблема обезболивания в торакальной хирургии и пути решения. Общая реаниматология 2011; VII (5): 46—56.Cheng E. Y.The cost of sedating and paralyzing the critically ill patient. Crit. Care Clin. 1995; 11 (4): 1005—1019.Cheng E. Y.The cost of sedating and paralyzing the critically ill patient. Crit. Care Clin. 1995; 11 (4): 1005—1019.Awissi D. K., Begin C., Moisan J. et al.I-SAVE study: impact of sedation, analgesia, and delirium protocols evaluated in the intensive care unit: an economic evaluation. Ann. Pharmacother 2012; 46 (1): 21—28.Awissi D. K., Begin C., Moisan J. et al.I-SAVE study: impact of sedation, analgesia, and delirium protocols evaluated in the intensive care unit: an economic evaluation. Ann. Pharmacother 2012; 46 (1): 21—28.Sessler C. N., Gosnel M. S., Grap M. J. et al.The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am. J. Respir. Crit. Care Med. 2002; 166 (10): 1338—1344.Sessler C. N., Gosnel M. S., Grap M. J. et al.The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am. J. Respir. Crit. Care Med. 2002; 166 (10): 1338—1344.Martin J., Heymann A., Basell K. et al.Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care — short version. Ger. Med. Sci. 2010; 8: Doc02.Martin J., Heymann A., Basell K. et al.Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care — short version. Ger. Med. Sci. 2010; 8: Doc02.Козлов И. А., Дудов П. Р., Дзыбинская Е. В.Ранняя активизация кар-диохирургических больных: история и терминология. Общая реаниматология 2010; VI (5): 66—73.Козлов И. А., Дудов П. Р., Дзыбинская Е. В.Ранняя активизация кар-диохирургических больных: история и терминология. Общая реаниматология 2010; VI (5): 66—73.Payen J. F., Chanques G., Mantz J. et al.Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology 2007; 106 (4): 687—695.Payen J. F., Chanques G., Mantz J. et al.Current practices in sedation and analgesia for mechanically ventilated critically ill patients: a prospective multicenter patient-based study. Anesthesiology 2007; 106 (4): 687—695.DeGradoJ. R., Anger K. E., Szumita P. M. et al.Evaluation of a local ICU sedation guideline on goal-directed administration of sedatives and analgesics. J. Pain Res. 2011; 4: 127—134.DeGradoJ. R., Anger K. E., Szumita P. M. et al.Evaluation of a local ICU sedation guideline on goal-directed administration of sedatives and analgesics. J. Pain Res. 2011; 4: 127—134.Schweickert W. D., Gehlbach B. K., Pohlman A. S. et al.Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit. Care Med. 2004; 32 (6): 1272—1276.Schweickert W. D., Gehlbach B. K., Pohlman A. S. et al.Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit. Care Med. 2004; 32 (6): 1272—1276.Mehta S., Burry L., Fischer S. et al.Canadian survey of the use of sedatives, analgesics, and neuromuscular blocking agents in critically patients. Crit. Care Med. 2006; 34 (2): 374—380.Mehta S., Burry L., Fischer S. et al.Canadian survey of the use of sedatives, analgesics, and neuromuscular blocking agents in critically patients. Crit. Care Med. 2006; 34 (2): 374—380.Egerod I., Christensen B. V., Johansen L.Trends in sedation practices in Danish intensive care units in 2003: a national survey. Intensive Care Med. 2006; 32 (1): 60—66.Egerod I., Christensen B. V., Johansen L.Trends in sedation practices in Danish intensive care units in 2003: a national survey. Intensive Care Med. 2006; 32 (1): 60—66.Martin J., Franck M., Sigel S. et al.Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey. Crit. Care. 2007; 11 (6): R124.Martin J., Franck M., Sigel S. et al.Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey. Crit. Care. 2007; 11 (6): R124.Mehta S., Burry L., Martinez-MottaJ. C. et al.A randomized trial of daily awakening in critically ill patients managed with a sedation protocol: a pilot trial. Crit. Care Med. 2008; 36 (7): 2092—2099.Mehta S., Burry L., Martinez-MottaJ. C. et al.A randomized trial of daily awakening in critically ill patients managed with a sedation protocol: a pilot trial. Crit. Care Med. 2008; 36 (7): 2092—2099.Jackson D. L., Proudfoot C. W., Cann K. F., Walsh T. S.The incidence of sub-optimal sedation in the ICU: a systematic review. Crit. Care 2009; 13 (6): R204.Jackson D. L., Proudfoot C. W., Cann K. F., Walsh T. S.The incidence of sub-optimal sedation in the ICU: a systematic review. Crit. Care 2009; 13 (6): R204.Aubrun F., Paqueron X., Langeron O. et al.What pain scales do nurses use in the postanaesthesia care unit? Eur. J. Anaesthesiol. 2003; 20 (9): 745—749.Aubrun F., Paqueron X., Langeron O. et al.What pain scales do nurses use in the postanaesthesia care unit? Eur. J. Anaesthesiol. 2003; 20 (9): 745—749.Payen J. F., Bru O., Bosson J. L. et al.Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit. Care Med. 2001; 29 (12): 2258—2263.Payen J. F., Bru O., Bosson J. L. et al.Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit. Care Med. 2001; 29 (12): 2258—2263.Al M. J., Hakkaart L., Tan S. S., Bakker J.Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands. Crit. Care 2010; 14 (6): R195.Al M. J., Hakkaart L., Tan S. S., Bakker J.Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands. Crit. Care 2010; 14 (6): R195.Cevik F., Celik M., Clark P. M., Macit C.Sedation and analgesia in intensive care: a comparison of fentanyl and remifentanil. Pain Res. Treat. 2011; 2011: 650320.Cevik F., Celik M., Clark P. M., Macit C.Sedation and analgesia in intensive care: a comparison of fentanyl and remifentanil. Pain Res. Treat. 2011; 2011: 650320.Зильберт Е. В., Степаненко С. М., Беляева И. Д., Фридлянд М. И.Влияние продленной инфузии промедола на восстановление самостоятельного дыхания у детей в послеоперационном периоде. Общая реаниматология 2011; VII (1): 58—64.Зильберт Е. В., Степаненко С. М., Беляева И. Д., Фридлянд М. И.Влияние продленной инфузии промедола на восстановление самостоятельного дыхания у детей в послеоперационном периоде. Общая реаниматология 2011; VII (1): 58—64.Salluh J. I., Soares M., Teles J. M. et al.Delirium epidemiology in critical care (DECCA): an international study. Crit. Care 2010; 14 (6): R210.Salluh J. I., Soares M., Teles J. M. et al.Delirium epidemiology in critical care (DECCA): an international study. Crit. Care 2010; 14 (6): R210.Milbrandt E. B., Angus D. C.Potential mechanisms and markers of critical illness-associated cognitive dysfunction. Curr. Opin. Crit. Care 2005; 11 (4): 355—359.Milbrandt E. B., Angus D. C.Potential mechanisms and markers of critical illness-associated cognitive dysfunction. Curr. Opin. Crit. Care 2005; 11 (4): 355—359.Hopkins R. O., Weaver L. K., Collingridge D. et al.Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am. J. Respir. Crit. Care Med. 2005; 171 (4): 340—347.Hopkins R. O., Weaver L. K., Collingridge D. et al.Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am. J. Respir. Crit. Care Med. 2005; 171 (4): 340—347.Riker R. R., Shehabi Y., Bokesch P. M. et al.Dexmedetomidine vs mida-zolam for sedation of critically ill patients: a randomized trial. JAMA 2009; 301 (5): 489—499.Riker R. R., Shehabi Y., Bokesch P. M. et al.Dexmedetomidine vs mida-zolam for sedation of critically ill patients: a randomized trial. JAMA 2009; 301 (5): 489—499.Gerlach A. T., Dasta J. F.Dexmedetomidine: an updated review. Ann. Pharmacother. 2007; 41 (2): 245—2Gerlach A. T., Dasta J. F.Dexmedetomidine: an updated review. Ann. Pharmacother. 2007; 41 (2): 245—2Nelson L. E., Lu J., Guo T. et al.The a2—adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology 2003; 98 (2): 428—436.Nelson L. E., Lu J., Guo T. et al.The a2—adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology 2003; 98 (2): 428—436.Dasta J. F., Kane-Gill S. L., Pencina M. et al.A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit. Crit. Care Med. 2010; 38 (2): 497—503.Dasta J. F., Kane-Gill S. L., Pencina M. et al.A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit. Crit. Care Med. 2010; 38 (2): 497—503.Finnerty M., Marczynski T.J., Amirault H.J. et al.Benzodiazepines inhibit neutrophil chemotaxis and superoxide production in a stimulus dependent manner; PK-11195 antagonizes these effects. Immunopharmacology 1991; 22 (3): 185—193.Finnerty M., Marczynski T.J., Amirault H.J. et al.Benzodiazepines inhibit neutrophil chemotaxis and superoxide production in a stimulus dependent manner; PK-11195 antagonizes these effects. Immunopharmacology 1991; 22 (3): 185—193.Kim S. N., Son S. C., Lee S. M. et al.Midazolam inhibits proinflammato-ry mediators in the lipopolysaccharide-activated macrophage. Anesthesiology 2006; 105 (1): 105—110.Kim S. N., Son S. C., Lee S. M. et al.Midazolam inhibits proinflammato-ry mediators in the lipopolysaccharide-activated macrophage. Anesthesiology 2006; 105 (1): 105—110.Weatherby K. E., Zwilling B. S., Lafuse W. P.Resistance of macrophages to Mycobacterium avium is induced by alpha2—adrenergic stimulation. Infect. Immun. 2003; 71 (1): 22—29.Weatherby K. E., Zwilling B. S., Lafuse W. P.Resistance of macrophages to Mycobacterium avium is induced by alpha2—adrenergic stimulation. Infect. Immun. 2003; 71 (1): 22—29.Gets J., Monroy F. P.Effects of alpha- and beta-adrenergic agonists on Toxoplasma gondii infection in murine macrophages. J. Parasitol. 2005; 91 (1): 193—195.Gets J., Monroy F. P.Effects of alpha- and beta-adrenergic agonists on Toxoplasma gondii infection in murine macrophages. J. Parasitol. 2005; 91 (1): 193—195.Nishina K., Akamatsu H., Mikawa K. et al.The effects of clonidine and dexmedetomidine on human neutrophil functions. Anesth. Analg. 1999; 88 (2): 452—458.Nishina K., Akamatsu H., Mikawa K. et al.The effects of clonidine and dexmedetomidine on human neutrophil functions. Anesth. Analg. 1999; 88 (2): 452—458.Ma D, Hossain M., Rajakumaraswamy N. et al.Dexmedetomidine produces its neuroprotective effect via the a-2A-adrenoceptor subtype. Eur. J. Pharmacol. 2004; 502 (1—2): 87—97.Ma D, Hossain M., Rajakumaraswamy N. et al.Dexmedetomidine produces its neuroprotective effect via the a-2A-adrenoceptor subtype. Eur. J. Pharmacol. 2004; 502 (1—2): 87—97.Sanders R. D., Xu J., Shu Y. et al.Dexmedetomidine attenuates isoflu-rane-induced neurocognitive impairment in neonatal rats. Anesthesiology 2009; 110 (5): 1077—1085.Sanders R. D., Xu J., Shu Y. et al.Dexmedetomidine attenuates isoflu-rane-induced neurocognitive impairment in neonatal rats. Anesthesiology 2009; 110 (5): 1077—1085.Pandharipande P. P., Pun B. T., Herr D. L. et al.Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007; 298 (22): 2644—2653.Pandharipande P. P., Pun B. T., Herr D. L. et al.Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007; 298 (22): 2644—2653.Pandharipande P. P., Sanders R. D., Girard T. D. et al.Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial. Crit. Care. 2010; 14 (2): R38.Pandharipande P. P., Sanders R. D., Girard T. D. et al.Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial. Crit. Care. 2010; 14 (2): R38.Reade M. C., O ‘Sullivan K., Bates S. et al.Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Crit. Care. 2009; 13 (3): R75.Reade M. C., O ‘Sullivan K., Bates S. et al.Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Crit. Care. 2009; 13 (3): R75.Alasad J, Ahmad M.Communication with critically ill patients. J. Adv Nurs. 2005; 50 (4): 356—362.Alasad J, Ahmad M.Communication with critically ill patients. J. Adv Nurs. 2005; 50 (4): 356—362.Wojnicki-Johansson G.Communication between nurse and patient during ventilator treatment: patient reports and RN evaluations. Intensive Crit. Care Nurs. 2001; 17 (1): 29—39.Wojnicki-Johansson G.Communication between nurse and patient during ventilator treatment: patient reports and RN evaluations. Intensive Crit. Care Nurs. 2001; 17 (1): 29—39.Fleischer S., Berg A., Neubert T. R. et al.Structured information during the ICU stay to reduce anxiety: study protocol of a multicenter randomized controlled trial. Trials 2009; 10: 84.Fleischer S., Berg A., Neubert T. R. et al.Structured information during the ICU stay to reduce anxiety: study protocol of a multicenter randomized controlled trial. Trials 2009; 10: 84.Hwang S. L., Chang Y., Ko W. J., Lee M. B.Stress-reducing effect of physician’s tape-recorded support on cardiac surgical patients in the intensive care unit. J. Formos Med. Assoc. 1998; 97 (3): 191—196.Hwang S. L., Chang Y., Ko W. J., Lee M. B.Stress-reducing effect of physician’s tape-recorded support on cardiac surgical patients in the intensive care unit. J. Formos Med. Assoc. 1998; 97 (3): 191—196.Ely E. W., Margolin R., Francis J. et al.Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit. Care Med. 2001; 29 (7): 1370—1379.Ely E. W., Margolin R., Francis J. et al.Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit. Care Med. 2001; 29 (7): 1370—1379.Spronk P. E., Riekerk B., Hofhuis J., RommesJ. H.Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med. 2009; 35 (7): 1276—1280.Spronk P. E., Riekerk B., Hofhuis J., RommesJ. H.Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med. 2009; 35 (7): 1276—1280.Page V. J., Navarange S., Gama S., McAuley D. F.Routine delirium monitoring in a UK critical care unit. Crit. Care 2009; 13 (1): R16.Page V. J., Navarange S., Gama S., McAuley D. F.Routine delirium monitoring in a UK critical care unit. Crit. Care 2009; 13 (1): R16.W0ien H., Stubhaug A., Bj0rk I. T.Analgesia and sedation of mechanically ventilated patients — a national survey of clinical practice. Acta Anaesthesiol. Scand. 2012; 56 (1): 23—29.W0ien H., Stubhaug A., Bj0rk I. T.Analgesia and sedation of mechanically ventilated patients — a national survey of clinical practice. Acta Anaesthesiol. Scand. 2012; 56 (1): 23—29.

The authors declare that there are no conflicts of interest present.