Sedation in the Intensive Care Unit

Agitation is a frequent problem among patients in the intensive care unit, particularly those requiring mechanical ventilation. Physicians have been criticized for providing insufficient sedation to treat these patients. More recently, there is increasing concern that excessive sedation may be an equal or even greater problem, contributing to adverse outcomes such as prolonged mechanical ventilation. Techniques that may improve practice in this area include an organized approach to evaluating the agitated patient and searching for correctable causes, using clinical or physiologic sedation scales to guide treatment, tailoring therapy to meet the needs of individual patients, and considering the use of practice parameters or guidelines to support rational therapy. A sound understanding of the pharmacologic properties of the medications used for analgesia and sedation is indispensable. In the future, improved agents, better tools for assessing patients, and a better understanding of the impact of sedation on clinical outcomes will undoubtedly improve practice in this important area of critical care.