Cooperative Sedation in Intensive Care Unit

Abstract

I n the last three decades, intensive care units (ICUs) and critical care researchers have amassed a body of patho-physiologic knowledge that has advanced the care of ICU patients. Sedation is an important component of the treatment of ICU patients especially who require mechanical ventilation. Directing treatment to specific and individualized goals will ensure that patient needs are met. All currently available sedatives for use in the ICU have limitations. Rather than seeking an ideal drug, strategies of drug administration that focus attention on principles of sedative pharmacology in ICU should be used. Recognition of the goals of sedation in individual patients will allow rational administration strategies to be implemented in the care of these patients. Administration of analgesics and sedatives is commonplace in the ICU. Unfortunately, many early studies of analgesic and sedative medications were performed in the operating room, a setting very different from the ICU. The clinician must recognize the diverse and often unpredictable effects of critical illness on the pharmaco-kinetics and pharmaco-dynamics of sedatives and analgesics. Failure to recognize these effects may lead to inadequate or excessive sedation.