Abstract
Critically ill intensive care unit (ICU) patients often require sedation to tolerate
life-saving interventions such as mechanical ventilation. Pain, anxiety, and delirium
all contribute to patient distress and agitation which can interfere with ICU medical
care if not addressed and treated appropriately. Sedation practices to treat pain,
anxiety, and delirium that deviate from established practice guidelines affect mechanical
ventilation duration, ICU and hospital length of stay, functional impairment, and
mortality. Historically patients were kept deeply sedated in the ICU. However, considerable
research has demonstrated that minimizing sedation with the goal to achieve comfortable
wakefulness is preferred in most ICU patients and is associated with improved clinical
outcomes. This review will focus on changes in sedation practice in the ICU over the
past three decades. With the implementation of validated sedation assessment scales,
a multidisciplinary treatment model, and development of daily awakening protocols,
no or minimal sedation can be achieved in the majority of ICU patients. Frequent,
careful consideration of the environmental stimuli that contribute to patient discomfort
and agitation and judicious use of sedative medications individualized to each patient
are important in achieving this goal.
Keywords
sedation - agitation - ICU outcomes - sedation scales - pain - anxiety - delirium
