Sedation in the intensive care setting

Christopher G Hughes, Stuart McGrane, Pratik P PandharipandeVanderbilt University School of Medicine, Nashville, TN, USAAbstract: Critically ill patients are routinely provided analgesia and sedation to prevent pain and anxiety, permit invasive procedures, reduce stress and oxygen consumption, and i...

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Autores principales:	Hughes CG, McGrane S, Pandharipande PP
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2012
Materias:	Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/66e223640b21442d811f49c4af6befb6
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spelling	oai:doaj.org-article:66e223640b21442d811f49c4af6befb62021-12-02T03:01:27ZSedation in the intensive care setting1179-1438https://doaj.org/article/66e223640b21442d811f49c4af6befb62012-10-01T00:00:00Zhttp://www.dovepress.com/sedation-in-the-intensive-care-setting-a11342https://doaj.org/toc/1179-1438Christopher G Hughes, Stuart McGrane, Pratik P PandharipandeVanderbilt University School of Medicine, Nashville, TN, USAAbstract: Critically ill patients are routinely provided analgesia and sedation to prevent pain and anxiety, permit invasive procedures, reduce stress and oxygen consumption, and improve synchrony with mechanical ventilation. Regional preferences, patient history, institutional bias, and individual patient and practitioner variability, however, create a wide discrepancy in the approach to sedation of critically ill patients. Untreated pain and agitation increase the sympathetic stress response, potentially leading to negative acute and long-term consequences. Oversedation, however, occurs commonly and is associated with worse clinical outcomes, including longer time on mechanical ventilation, prolonged stay in the intensive care unit, and increased brain dysfunction (delirium and coma). Modifying sedation delivery by incorporating analgesia and sedation protocols, targeted arousal goals, daily interruption of sedation, linked spontaneous awakening and breathing trials, and early mobilization of patients have all been associated with improvements in patient outcomes and should be incorporated into the clinical management of critically ill patients. To improve outcomes, including time on mechanical ventilation and development of acute brain dysfunction, conventional sedation paradigms should be altered by providing necessary analgesia, incorporating propofol or dexmedetomidine to reach arousal targets, and reducing benzodiazepine exposure.Keywords: fentanyl, propofol, dexmedetomidine, Behavioral Pain Scale, Richmond Agitation-Sedation Scale, Sedation-Agitation Scale, Confusion Assessment Method for the ICUHughes CGMcGrane SPandharipande PPDove Medical PressarticleTherapeutics. PharmacologyRM1-950ENClinical Pharmacology: Advances and Applications, Vol 2012, Iss default, Pp 53-63 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Therapeutics. Pharmacology RM1-950
spellingShingle	Therapeutics. Pharmacology RM1-950 Hughes CG McGrane S Pandharipande PP Sedation in the intensive care setting
description	Christopher G Hughes, Stuart McGrane, Pratik P PandharipandeVanderbilt University School of Medicine, Nashville, TN, USAAbstract: Critically ill patients are routinely provided analgesia and sedation to prevent pain and anxiety, permit invasive procedures, reduce stress and oxygen consumption, and improve synchrony with mechanical ventilation. Regional preferences, patient history, institutional bias, and individual patient and practitioner variability, however, create a wide discrepancy in the approach to sedation of critically ill patients. Untreated pain and agitation increase the sympathetic stress response, potentially leading to negative acute and long-term consequences. Oversedation, however, occurs commonly and is associated with worse clinical outcomes, including longer time on mechanical ventilation, prolonged stay in the intensive care unit, and increased brain dysfunction (delirium and coma). Modifying sedation delivery by incorporating analgesia and sedation protocols, targeted arousal goals, daily interruption of sedation, linked spontaneous awakening and breathing trials, and early mobilization of patients have all been associated with improvements in patient outcomes and should be incorporated into the clinical management of critically ill patients. To improve outcomes, including time on mechanical ventilation and development of acute brain dysfunction, conventional sedation paradigms should be altered by providing necessary analgesia, incorporating propofol or dexmedetomidine to reach arousal targets, and reducing benzodiazepine exposure.Keywords: fentanyl, propofol, dexmedetomidine, Behavioral Pain Scale, Richmond Agitation-Sedation Scale, Sedation-Agitation Scale, Confusion Assessment Method for the ICU
format	article
author	Hughes CG McGrane S Pandharipande PP
author_facet	Hughes CG McGrane S Pandharipande PP
author_sort	Hughes CG
title	Sedation in the intensive care setting
title_short	Sedation in the intensive care setting
title_full	Sedation in the intensive care setting
title_fullStr	Sedation in the intensive care setting
title_full_unstemmed	Sedation in the intensive care setting
title_sort	sedation in the intensive care setting
publisher	Dove Medical Press
publishDate	2012
url	https://doaj.org/article/66e223640b21442d811f49c4af6befb6
work_keys_str_mv	AT hughescg sedationintheintensivecaresetting AT mcgranes sedationintheintensivecaresetting AT pandharipandepp sedationintheintensivecaresetting
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Sedation in the intensive care setting

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