ICU sedation

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Background

  • Sedation is commonly used for ICU patients
  • Agent choice determined by side effect profile and disease process
  • Common ICU uses
    • Control agitation
    • Improve patient-ventilator synchrony
    • Decreases O2 consumption
    • Decrease intracranial pressure

Agents

Adverse Effects

  • Drug and dose dependent, but generally include:
    • Hypotension
    • Respiratory depression
    • Withdrawal
    • Delirium
    • Arrhythmias

Monitoring of Sedation

  • Several sedation monitoring scales are validated
  • Richmond Agitation and Sedation Scale (RASS) most commonly used (RASS)

Considerations

  • Lighter sedation associated with shorter ICU stay, decreased time on ventilator[1]
  • Deeper sedation associated with prolonged ICU stay, increased 6 month mortality[2]
  • Dexmedetomidine or propofol sedation may reduce ICU stay, time on ventilator, when compared with benzodiazepines[3]
    • SCCM Recommendation, level 2B (weak recommendation)[4]

See Also

References

  1. Jacobi, J., Fraser, G. L., Coursin, D. B., Riker, R. R., Fontaine, D., Wittbrodt, E. T., Chalfin, D. B., Masica, M. F., Bjerke, S. H., Coplin, W. M., Crippen, D. W., Fuchs, B. D., Kelleher, R. M., Marik, P. E., Nasraway, S. A., Murray, M. J., Peruzzi, W. T. and Lumb, P. D. (2002) ‘Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult’, Critical Care Medicine, 30(1), pp. 119–141.
  2. Shehabi, Y., Bellomo, R., Reade, M. C., Bailey, M., Bass, F., Howe, B., McArthur, C., Seppelt, I. M., Webb, S. and Weisbrodt, L. (2012) ‘Early Intensive Care Sedation Predicts Long-Term Mortality in Ventilated Critically Ill Patients’, American Journal of Respiratory and Critical Care Medicine, 186(8), pp. 724–731.
  3. Fraser, G. L., Devlin, J. W., Worby, C. P., Alhazzani, W., Barr, J., Dasta, J. F., Kress, J. P., Davidson, J. E. and Spencer, F. A. (2013) ‘Benzodiazepine Versus Nonbenzodiazepine-Based Sedation for Mechanically Ventilated, Critically Ill Adults’, Critical Care Medicine, 41pp. 30–38.
  4. Barr, J., Fraser, G. L., Puntillo, K., Ely, W. E., Gélinas, C., Dasta, J. F., Davidson, J. E., Devlin, J. W., Kress, J. P., Joffe, A. M., Coursin, D. B., Herr, D. L., Tung, A., Robinson, B. R. H., Fontaine, D. K., Ramsay, M. A., Riker, R. R., Sessler, C. N., Pun, B., Skrobik, Y. and Jaeschke, R. (2013) ‘Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit’, Critical Care Medicine, 41(1), pp. 278–280.

Authors:

Ross Donaldson