Sedation and analgesia constitute a fundamental part of the daily clinical practice in intensive care units (ICUs). Its use is necessary to provide comfort, pain relief, anxiolysis, and amnesia to patients subjected to distressing procedures such as mechanical ventilation. It has been demonstrated that adequate sedoanalgesia lessens stress-related events in the critically ill patients, facilitating their management and improving their outcomes. However, misuse of sedatives and analgesics may carry the risk of unrecognized enduring deleterious immediate and long-term consequences such as prolonged mechanical ventilation, ICU and hospital time, and psychological distress. For these reasons, a number of sedation and analgesia strategies have been proposed to provide the minimal effective dose during the shortest possible time to avoid the adverse effects derived from agent accumulation.
Patient-targeted sedation protocols, analgesia-based sedation strategies, and several interventions such as daily interruption or sequential use of sedatives have been proven to optimize patient comfort whereas minimizing awakening time or mechanical ventilator duration and maximizing patient awareness of their surroundings.
However, despite the proven beneficial effects of these strategies, their implementation continues to be a challenge to the ICU professionals. Sedation and analgesia strategies should be designed to meet the particular physical and human characteristics of the area where it is to be implemented. Similarly, their implementation should be carried out by multidisciplinary teams that focus on the specific characteristics and circumstances of the patient.
One of every 3 patients admitted in an intensive care unit undergoes mechanical ventilation. Sedation and analgesia are required to facilitate patient tolerance to such an aggressive procedure, diminishing stress response, relieving pain and anxiety, ensuring patient comfort, and facilitating nursing care. However, misuse of sedatives and analgesics may impact negatively on critically ill patients. The recognition of the potential for enduring effects derived from sedative and analgesic misuse, the availability of new agents, and the growing emphasis on cost containment have led to important changes in the way that sedation and analgesia practices are implemented. The aim of the present review is to discuss the agents, indications, complications, and most important strategies to optimize the sedation and analgesic practices in the intensive care unit.
From the Critical Care Department, University Hospital Joan XXIII, Tarragona, Spain.
Supported in part by CIBER 06/06/0036 and 2009/SGR/1226.
Address correspondence to: A. Sandiumenge, MD, PhD, Critical Care Department, University Hospital Joan XXIII, C/Dr. Mallafre Guasch, 4, 43007 Tarragona, Spain. E-mail: firstname.lastname@example.org.