- 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
- For intubated and mechanically ventilated patients who are unable to clearly communicate the source of agitation, analgesia should always be provided first
- Dexmedetomidine → useful as adjunct treatment for severe alcohol withdrawal in the ICU; associated with a reduction in short-term alcohol withdrawal symptoms in ICU patients
- Drug and dose dependent, but generally include:
- Respiratory depression
Monitoring of Sedation
- Several sedation monitoring scales are validated
- Richmond Agitation and Sedation Scale (RASS) most commonly used (RASS)
- The COMFORT scale is a valid and reliable system for assessing sedation, distress, and pain in nonverbal pediatric patients
- Lighter sedation associated with shorter ICU stay, decreased time on ventilator
- Deeper sedation associated with prolonged ICU stay, increased 6 month mortality
- Dexmedetomidine or propofol sedation may reduce ICU stay, time on ventilator, when compared with benzodiazepines
- SCCM Recommendation, level 2B (weak recommendation)
- Beg, M., Fisher, S., Siu, D., Rajan, S., Troxell, L., & Liu, V. X. (2016). Treatment of Alcohol Withdrawal Syndrome with and without Dexmedetomidine. The Permanente journal, 20(2), 49–53. https://doi.org/10.7812/TPP/15-113
- 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.
- 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.
- 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.
- 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.