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Semin Respir Crit Care Med 2014; 35(04): 441-450
DOI: 10.1055/s-0034-1382156
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Sedation and Analgesia in Mechanical Ventilation

Thomas Strøm
1   Department of Anaesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
,
Palle Toft
1   Department of Anaesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
› Author Affiliations
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Publication History

Publication Date:
11 August 2014 (online)

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Abstract

Traditionally, critically ill patients undergoing mechanical ventilation (MV) have received sedation. Over the last decade, randomized controlled trials have questioned continued use of deep sedation. Evidence shows that a nurse-driven sedation protocol reduces length of MV compared with standard strategy with sedation. Furthermore, daily interruption of sedation reduces length of MV, intensive care unit (ICU), and hospital length of stay (LOS). A larger scale trial with daily interruption of sedation has confirmed these findings and furthermore showed a reduction in 1-year mortality with the use of daily interruption of sedation. Recently, a strategy with no sedation has been described reporting a reduction in length of MV, ICU, and hospital LOS compared with a strategy with daily interruption of sedation. Follow-up trials report that reducing sedation does not seem to increase the risk of psychological morbidity. Moreover, delirium has gained increased focus in recent years with development of validated tools to detect both hyperactive and hypoactive forms of delirium. Using validated tools for detecting delirium is important in monitoring and detecting acute brain dysfunction in critically ill patients. Evidence from randomized trials also cites a beneficial effect of early mobilization with respect to length of MV and delirium.

Keywords

analgesics - critical illness - hypnotics and sedatives - intensive care - length of stay - delirium - mechanical ventilation
 

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