Sedation, Delirium and Early Mobilization in Critically Ill Patients

Abstract

Background: Analgesia and sedation is used in the ICU to provide comfort and ensure patient safety, especially in those who are mechanically ventilated. Although analgesia and sometimes sedation is necessary in an ICU, when over used without goals and targets, they predispose patients to untoward complications of increased time on mechanical ventilation, longer times in the ICU, more radiological testing for altered mental status, ICU-Acquired Weakness and greater likelihood of delirium. Aims: The aim of this essay is to review the current medical literature regarding the optimum protocol for sedation in critically ill patients, methods to detect, prevent and treat delirium and the role of early mobilization in minimizing ICU delirium and ICU acquired weakness. Conclusion: Critically ill patients are frequently prescribed sedatives and analgesics – especially if they are on mechanical ventilation (MV) – to ensure patient safety, to relieve pain and anxiety, to reduce stress and oxygen consumption, and to prevent patient ventilator non-synchrony. Scientific advances in the past 10 to 15 years have revealed that these medications themselves contribute to increased morbidity, and perhaps even mortality.