TO MINIMIZE PATIENT DISCOMfort in the intensive care unit (ICU), sedation has become an integral part of critical care practice. Sedation reduces the stress response, provides anxiolysis, improves tolerance of ventilatory support, and facilitates nursing care. Unfortunately, sedatives have adverse effects, have the potential to prolong mechanical ventilation, and may increase health care costs....

BACKGROUND We offer some perspectives and commentary on the sedation of obese patients in the intensive care unit (ICU). DISCUSSION Sedation in morbidly obese patients should conform to the same broad principles now current in ICU practice. These include a general presumption against benzodiazepines as first-line agents. Opioids should be avoided in any situation where spontaneous breathing i...

BACKGROUND Somatosensory (SSEP) and brainstem auditory (BAEP) evoked potentials are neurophysiological tools which, respectively, explore the intracranial conduction time (ICCT) and the intrapontine conduction time (IPCT). The prognostic values of prolonged cerebral conduction times in deeply sedated patients have never been assessed. Sedated patients are at risk of developing new neurological ...

Over the past decade, most Canadian intensive care units (ICUs) have adopted locally developed standardized protocols for delivery of analgesics and sedatives to patients who are undergoing mechanical ventilation to alleviate pain, anxiety, and agitation. Although I do acknowledge the benefits of protocol-ized care, not all patients have the same needs with respect to sedation and analgesia, so...

Deep sedation is known to be associated with poor long-term outcomes in critically ill patients, including cognitive and psychological complications and increased mortality. Yet many patients still receive high levels of sedation, particularly during the early days of their intensive care unit (ICU) stay. The eCASH (early Comfort using Analgesia, minimal Sedatives and maximal Humane care) conce...

P from the late 1980s suggested that approximately half of the patients in the ICU described their period of mechanical ventilation as unpleasant and stressful, and that their time requiring mechanical ventilation was associated with fear, agony, and panic. In the late 1990s and more recently, publications have suggested that the administration of large quantities of sedation in the ICU leads t...

BACKGROUND Use of dexmedetomidine or propofol rather than a benzodiazepine sedation strategy may improve ICU outcomes. We reviewed randomized trials comparing a benzodiazepine and nonbenzodiazepine regimen in mechanically ventilated adult ICU patients to determine if differences exist between these sedation strategies with respect to ICU length of stay, time on the ventilator, delirium prevalen...

BACKGROUND The practice of low vs. high sedation dosing strategy may impact the cognitive and mental health function in the intensive care unit (ICU). We aim to demonstrate that high sedation strategy will result in change of mental health function in ICU patients. METHODS We performed a systemic search and meta-analysis of medical databases in MEDLINE (from 1966 to March 2013) and EMBASE (fr...

INTRODUCTION Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV). ...

OBJECTIVE Meaningful use of electronic health records (EHRs) is dependent on accurate clinical documentation. Documenting common goals in the intensive care unit (ICU), such as sedation and ventilator management plans, may increase collaboration and decrease patient length of stay. This study analyzed the degree to which goals stated were present in the EHR. DESIGN Descriptive correlational s...