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UNIVERSITY OF PENNSYLVANIA STUDY INVESTIGATES 'RIP VAN WINKLE STATE' OF SUSPENDED ANIMATION

 UNIVERSITY OF PENNSYLVANIA STUDY INVESTIGATES
 'RIP VAN WINKLE STATE' OF SUSPENDED ANIMATION
 PHILADELPHIA, Nov. 27 /PRNewswire/ -- A University of Pennsylvania study has identified a serious lack of understanding at medical intensive care units regarding a state of suspended animation experienced by some respiratory patients.
 Medical intensive-care patients with respiratory failure commonly receive powerful sedatives and paralyzing drugs for days, sometimes even weeks and months, while they are mechanically ventilated to sustain breathing.
 According to a recent study by John Hansen-Flaschen, M.D., director of the Pulmonary and Critical Care Division at the University of Pennsylvania Medical Center, there is no consensus regarding the optimal use of sedatives and paralyzing drugs in medical intensive care units (ICUs) and little understanding about what Hansen-Flaschen calls the "Rip van Winkle state" that results from their use. The study appears in the Nov. 27 issue of the Journal of the American Medical Association.
 "We found that the use of sedating drugs and neuromuscular blockers is extensive and routine in medical ICUs," said Hansen-Flaschen, "yet remarkably little is known about the physical and mental effects of their use over a prolonged period."
 The Rip van Winkle state is a result of potent sedatives and neuromuscular blocking agents given to patients, often via continuous infusion, to help them tolerate the discomfort of mechanical ventilation and to prevent any physical movement that may interfere with the procedure.
 Patients receiving mechanical ventilation typically have experienced respiratory failure as a result of severe pneumonia, auto accident, drug overdose, massive organ failure due to hypothermia, severe smoke inhalation or other causes. Some of these patients remain in the ICU for one to three days, others for weeks, even months.
 Concerned about what he calls a "black hole" of information regarding this period of total paralysis, Hansen-Flaschen developed a questionnaire that he sent to all 265 U.S. medical ICUs that train pulmonary fellows. The questionnaire focused on the use of sedating drugs and neuromuscular blocking agents during mechanical ventilation for respiratory failure.
 "We found that nearly all the ICUs use sedatives and paralyzing agents generously with patients on mechanical ventilation," said Hansen- Flaschen. But despite the widespread use, "no consensus has emerged as to which drugs to use and how to use them."
 For example, 17 different sedating drugs were identified by the ICUs, nine of them used frequently. On average, each ICU used approximately five different sedatives. There was no consensus observed regarding whether to administer the drugs via intravenous, intramuscular or subcutaneous routes, or whether to administer them continuously or intermittently.
 It is commonly assumed that heavily sedated and paralyzed patients are not conscious beneath their paralysis. Recent findings suggest otherwise, noted Hansen-Flaschen, and some patients are reporting memories from the Rip van Winkle state. "Our single most important need now is for techniques to measure the experience," he stressed. "The question of humane treatment must be addressed."
 /delval/
 -0- 11/27/91
 /CONTACT: Rebecca Harmon or Terese Vekteris of the University of Pennsylvania Medical Center, 215-662-2560/ CO: Hospital of the University of Pennsylvania ST: Pennsylvania IN: HEA SU:


KA-JS -- PHFNS2 -- 7599 11/27/91 07:32 EST
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Date:Nov 27, 1991
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