Sedation in the intensive care unit: a call for evidence.

Sedation in the intensive care unit (ICU), long considered a necessary but relatively benign adjunct to patient management, is now recognized as an important determinant of patient morbidity. The implementation of nursedriven sedation protocols that minimize continuous sedative infusions, and daily interruption of infusions to allow patient awakening, have been shown to reduce the duration of mechanical ventilation and ICU stay.1–3 Two sedatives have been associated with mortality: etomidate, because of its inhibitory effect on adrenal function, and propofol, because of its association with cardiac failure and rhabdomyolysis (“propofol infusion syndrome”). In addition, recent evidence suggests that specific sedative agents are associated with the transition to delirium in the ICU,4 which in turn is associated with both increased morbidity and mortality.5,6 However, considerable gaps remain in our knowledge of how to sedate critically ill patients, both in terms of specific agents and depth of sedation.