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Update on Sedation in the Critical Care Unit

Recognition and treatment of pain, agitation and anxiety is a challenge in the care of Intensive Care Unit (ICU) patients. Management of pain, agitation and anxiety is necessary for patient comfort, and reduces long term psychological sequelae of ICU admission, time on mechanical ventilation, and length of stay in both the ICU and hospital. ICU providers must be very familiar with the pharmacologic agents available and their appropriate use. Objective, easy to use, reliable and reproducible scales to assess pain and level of sedation are necessary to provide adequate treatment and to avoid untoward effects. Lighter sedation is presently the accepted goal and newer sedatives with safer side effect profiles are being used. Neuromuscular blocking agents continue to be recommended in certain clinical situations and for as short a time period as possible. Delirium is a common problem that must be prevented with early mobilization and promotion of sleep by creating an optimal environment. The use of dexmedetomidine in at-risk mechanically ventilated patients and atypical antipsychotics may be beneficial and reduce the duration of delirium.