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Semin Respir Crit Care Med 2015; 36(06): 899-913
DOI: 10.1055/s-0035-1564875
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Awake or Sedated: Trends in the Evaluation and Management of Agitation in the Intensive Care Unit

Authors

  • Erin M. DeBiasi

    1   Department of Pulmonary Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut

  • Kathleen M. Akgün

    2   Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, VA-Connecticut, West Haven Campus, West Haven, Connecticut
    3   Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut

  • Margaret Pisani

    1   Department of Pulmonary Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
Further Information

Publication History

Publication Date:
23 November 2015 (online)

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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