Sedation in the intensive care setting

Abstract

Critically ill patients are routinely provided analgesia and sedation to prevent pain and anxiety, permit invasive procedures, reduce stress and oxygen consumption, and improve synchrony with mechanical ventilation. Regional preferences, patient history, institutional bias, and individual patient and practitioner variability, however, create a wide discrepancy in the approach to sedation of critically ill patients. Untreated pain and agitation increase the sympathetic stress response, potentially leading to negative acute and long-term consequences. Oversedation, however, occurs commonly and is associated with worse clinical outcomes, including longer time on mechanical ventilation, prolonged stay in the intensive care unit, and increased brain dysfunction (delirium and coma). Modifying sedation delivery by incorporating analgesia and sedation protocols, targeted arousal goals, daily interruption of sedation, linked spontaneous awakening and breathing trials, and early mobilization of patients have all been associated with improvements in patient outcomes and should be incorporated into the clinical management of critically ill patients. To improve outcomes, including time on mechanical ventilation and development of acute brain dysfunction, conventional sedation paradigms should be altered by providing necessary analgesia, incorporating propofol or dexmedetomidine to reach arousal targets, and reducing benzodiazepine exposure.

<p>Cost-Minimization Analysis of Dexmedetomidine Compared to Other Sedatives for Short-Term Sedation During Mechanical Ventilation in the United States</p>

“…2,3 Medications for sedation are routinely administered to critically ill patients treated in the ICU for a number of reasons, including to improve synchrony with or tolerance of MV. [6][7][8][9] The 2018 clinical practice guidelines from the Society of Critical Care Medicine (SCCM) recommend that light sedation be used in critically ill, mechanically ventilated adults. 7 Guidelines also generally recommend the use of nonbenzodiazepine sedatives (eg, propofol or dexmedetomidine) vs the use of benzodiazepine sedatives (eg, midazolam or lorazepam) in critically ill, mechanically ventilated patients because of the potential for improved short-term outcomes such as ICU length of stay (LOS), duration of MV, and delirium.…”

Patient stress in intensive care: comparison between a coronary care unit and a general postoperative unit

“…( 24 ) Thus, to optimize patient care and comfort and to minimize the deleterious effects associated with pharmacotherapy, healthcare professionals should achieve the right balance between the administration of analgesic and sedative drugs. ( 25 )…”

Spatio-temporal dynamics of multimodal EEG-fNIRS signals in the loss and recovery of consciousness under sedation using midazolam and propofol

“…For these reasons, patient satisfaction is also high after conscious sedation [ 3 , 4 ]. However, clinical problem (e.g., oversedation) can be caused by large discrepancies in patient history, sedative preference, institutional bias, and patient/practitioner variability [ 5 – 8 ]. In this respect, for safe sedation by general practitioner monitoring levels of consciousness is an important clinical issue during conscious sedation.…”