Sedation in the ICU

Abstract

The ICU is a hostile environment, and while pain is often the root cause of distress experienced by the patient in the unit, anxiety, dyspnoea, delirium and sleep deprivation may be additive or synergistic.1,2 Factors that provoke these components of distress include underlying medical conditions, acute medical/surgical illness, and “routine†critical care practices like mechanical ventilation, the presence of indwelling tubes and catheters, iatrogenic illness, medication side effects, turning and suctioning, and excessive noise and light in the ICU.3 With pain being central to ICU discomfort, current sedation strategies are based on providing analgesia first, and adding sedation as required (“analgo-sedationâ€). Sedation needs vary widely and are influenced by many pharmacokinetic and pharmacodynamic variables in this group of patients. Therefore, all sedation techniques must be patient-focused and individualised to patient needs. This goal directed pproach improves patient outcome and reduces the use of sedative drugs.4