ICU Sedation
GOAL OF ICU SEDATION: addressing the ...

ICU Sedation

GOAL OF ICU SEDATION: addressing the ICU triad of pain, agitation, and delirium

 1. Pain: Common, ↑ energy expenditure; analgesia alone adequate in some 

 2. Agitation: target RASS -1 to -2 in intubated pts

 3. Delirium: 16-89% ICU pts; a/w ↑ mortality, ↓ QOL, poor cognitive outcomes, deeper sedation

Go through the ABCDE Bundle daily on rounds; evidence-based measure for ICU pts a/w ↑vent free days (21 vs. 24d over a 28-day study period), ↓delirium (OR 0.55), ↓mortality (OR 0.56)

A – Spontaneous Awakening Trial (SAT): Daily interruptions of sedation ↓ ICU LOS, vent days; PTSD sx 

B – Spontaneous Breathing Trial (SBT): For pts who pass SAT, assess for suitability of extubation 

C – Choice of sedation: see below

D – Delirium: Assess CAM-ICU daily

E – Early mobility: ↓pressure sores, ↑functional status at discharge, ↓vent days, ↓delirium 


 • Opioids: Primarily analgesia. Side effects (SE): resp depr, tolerance, constipation (prescribe w/ bowel reg), ileus, ↑ delirium w/ ↑use

 • Non-BZD sedatives: primarily anesthesia, amnesia; do NOT provide pain control (analgesia) 

 • BZD: primarily amnesia, anxiolysis. SEs: resp depression, agitation, withdrawal/tolerance, ↑ duration of action w/ gtt vs. IVP

 • Anti-Psychotics: useful in treating delirium + helping to liberate agitated pts from ventilator; SEs: ↑ QTc, EPS, anti-cholinergic, NMS

#ICU #Sedation #criticalcare #diagnosis #management 
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