Current trends in long-term pharmacological sedation of the critically ill

Czech version

Authors: Stibor Bronislav; Schwameis Franz
Authors‘ workplace: ICU, Landesklinikum Baden bei Wien, Austria
Published in: Anest. intenziv. Med., 25, 2014, č. 4, s. 307-314
Category: Intensive Care Medicine - Review Article

Overview

Pain and stress are very common in critically ill patients. Provision of adequate analgesia and elimination of psychological discomfort are essential components of treatment goals on the ICU care. In the past few years there has been a focus on the side-effects of long-term sedation such as the presence of delirium, cognitive dysfunction, prolongation of the time on mechanical ventilation, and ICU and hospital length of stay. The new 2013 guidelines by the American College of Critical Care Medicine and Society of Critical Care Medicine have redefined the management of sedation, analgesia and prevention and treatment of the delirium.

The traditional approach represents giving sedatives to all mechanically ventilated patients. The principle of deep level sedation in all patients has become obsolete. There is a focus on pain management firstly with intravenous analgesics, and sedation is used only if needed. Sedation with modern nonbenzodiazepine drugs (such as dexmedetomidine) is preferred while benzodiazepine-based sedation should be used only in specific situations.

Implementation of scoring systems for effective monitoring of pain, depth of sedation and delirium is also essential.

Keywords:
sedation – analgesia – RASS – CAM-ICU – guidelines – delirium – benzodiazepines – dexmedetomidine

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