Evaluation of Sedation for the Unconscious Patient: Are We Still Far Away?

In our daily practice in intensive care unit, one of the “cornerstones” is to achieve adequate sedation for every patient. Intensive care unit (ICU) patients are often sedated, and a good hypnotic monitoring is important to assure an optimal level of sedation for every patient. Sedation monitoring can be achieved using subjective or objective methods. The most recent recommendations on management of sedation were published by Critical Care Medicine in January 2013. They recommend the use of subjective methods as the primary method to monitor sedation, with the use of objective methods only in paralyzed and comatose patients, in whom subjective methods cannot be used. Unfortunately in these last recommendations, the objective methods of sedation monitoring are listed without indicating any of them as the best method actually available to assure an adequate sedation. The aim of our study is to review the characteristics of each objective method of sedation monitoring, in order to understand which is the most appropriate in the current state. We found that several objective methods are adequate to monitor the level of sedation in paralyzed or comatose patients, although the data needs to be considered with caution, Bispectral Index (BIS) is suggested as the best method for monitoring sedation in most studies.