Sedation of critically ill patients in intensive care units: What's new?

Abstract

Sedation of critically ill patients is a highly important therapeutic aspect in Intensive Care Units (ICUs). Numerous studies have demonstrated that a sedated (calm) patient compared to an unsedated (restless, agitated, delirious) one achieves better treatment outcomes, fewer complications, shorter duration of mechanical lung ventilation, reduced ICU stay, shorter hospitalization, and lower mortality. The fundamental rule is to first ensure analgesia, followed by sedation. Shallow sedation is recommended to maintain patient cooperation, while deep sedation should be avoided except in specific clinical situations such as severe brain trauma or acute respiratory distress syndrome. Monitoring sedation in the ICU is mandatory, and for this purpose, simple scales such as the Richmond Agitation Sedation Scale (RASS) or the Riker Sedation-Agitation Scale (RSAS) are recommended. There is a wide range of medications available, each with advantages for specific clinical situations, but generally, propofol and dexmedetomidine are most recommended and commonly used. Non-pharmacological measures and interventions should also not be disregarded and should be systematically employed whenever possible to reduce agitation occurrences in the ICU