For more than a decade, ICU clinicians have studied the effects of sedation on the comfort and outcomes of their patients.1 Yet, even during clinical trials that closely implement protocol-driven sedation, 32% of patients were minimally- or non-arousable, but only 2.6% of these patients were given an oversedation rating.2 What might this rate discrepancy be in the absence of protocol-driven sedation? And how can clinicians improve care?
One first step is to examine the reasons why we turn to sedation, and then seek to manage the underlying causes.1
In this video, leading medical practitioners discuss the importance of evaluating agitation, discussing how pain, delirium, anxiety, ventilator asynchrony, and the ICU environment itself can lead to agitation in ICU patients.
By changing one habit—evaluating the causes of agitation, instead of immediately turning to sedation—the risk of oversedation may be reduced.1
And by using sedation more effectively, we can work together to potentially reduce ICU ventilation time.
Barr J, Fraser GL, Puntillo K, et al; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263-306.
Weinert CR, Calvin AD. Epidemiology of sedation and sedation adequacy for mechanically ventilated patients in a medical and surgical intensive care unit. Crit Care Med. 2007;35(2):393-401.