Sedation and Analgesia in the Intensive Care Unit
John P. Kress, Anne S. Pohlman, and Jesse B. Hall
Am J Respir Crit Care Med , 2002, Vol 166
Critically ill patients requiring mechanical ventilation are frequently treated with sedatives and analgesics. Kwnoledge about these medications is derived from operating room investigations, an environment often very different the intensive care unit (ICU). Recently, important complications related to sedation practices in the ICU and efforts to modify sedation practices in the ICU have begun. Sedation practices vary widely between institutions, partly because of institutional bias and partly because requirements for sedation vary greatly from patient to patient. This commentary discusses principles and goals of sedation in the ICU data from publications on this topic. Certainly, some patients in the ICU require little or no sedation. Nonpharmacological means (e.g., patient reassurance, positioning comfortably in bed) should be attempted initially in all patients; however, this commentary focuses on patients who require mechanical ventilation and pharmacological means of sedation. This commentary does not review individual medications for sedation and analgesia; the reader is referred to guidelines by Jacobi and coworkers (Jacobi et al., 2002) for a review of this topic.
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