Rethinking Sedation in the ICU

Analgesic and sedative medications are commonly given to manage pain, anxiety, and delirium in critically ill patients; such agents are also used to facilitate painful procedures and to promote greater tolerance of mechanical ventilation. The manner in which we administer, titrate, and monitor analgesia and sedation in the ICU can have an impact on both short- and long-term patient outcomes. The benefit of sedation strategies that limit drug exposure and promote greater wakefulness and patient interaction has been demonstrated in several randomized trials. The overall objective of sedation in the ICU has changed, such that a calm, comfortable, awake, and interactive patient is the goal. This can be achieved using an individualized, restrictive, goal-directed, and protocolized approach to analgo-sedation. This chapter discusses specific medications for analgo-sedation, administration, and monitoring strategies, and how these strategies relate to delirium in the ICU.