It is important to regularly review the indication and dosage of analgesia and anxiolytics (including but not limited to opioids and benzodiazepines) in patients mechanically ventilated for their burn injuries. Higher doses of opioids and benzodiazepines are associated with delays in extubation, an increased risk of systemic infections (including ventilator associated pneumonia), deep vein thrombosis, delirium, and longer hospital stays, which in turn result in deconditioning, and long-term psychological effects.
For more information:
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263-306. PMID: 23269131.
Fagin A, Palmieri T, Greenhalgh D, Sen S. A comparison of dexmedetomidine and midazolam for sedation in severe pediatric burn injury. J Burn Care Res. 2012;33(6):759-763. PMID: 23147214.
Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial [published correction appears in JAMA. 2013 Jan 16;309(3):237]. JAMA. 2012;308(19):1985-1992. PMID: 23180503.