This review has been prepared to assist the multidisciplinary Intensive Care (ICU) team determine the best sedative regimen for their patients. Sedation has been a ubiquitous and essential component of critical care since its beginnings and plays a cardinal role in allowing therapies to be undertaken whilst minimising patient distress. Sedation requirements vary widely between patients and at different times of their illness. Being ill in an ICU is nearly always very frightening and may require a number of painful or uncomfortable procedures. The sedative regimen must be tailored to the individual patient, necessitating a multimodal and multidisciplinary approach and does not simply involve the use of drugs. Adequate analgesia should be a fundamental part of this approach; sedation should never be given as a substitute for analgesia.
The term ‘sedation’ has become a catch-all phrase to describe everything from anxiolysis – ‘a little something to help you sleep’ – to a state of unresponsivenessthat mimics general anaesthesia. This imprecision in terminology emphasises the need to define precisely our aims when the decision to ‘sedate’ is made. In principle, the medical and nursing teams should always strive to use the minimum dose of
sedation to achieve the desired effects without compromising patient comfort and safety. There may, however, be situations where high doses of drugs are necessary to induce deep sedation verging on general anaesthesia. Indications for the use of sedative drugs in the ICU include:
- To alleviate pain
- To facilitate the use of an otherwise distressing treatment and minimise discomfort
- To augment the effectiveness of a treatment e.g., inverse ratio ventilation
- As a treatment in its own right e.g., seizure control or management of intra cranial pressure
- To reduce anxiety
- To control agitation
- For amnesia during neuromuscular blockade
