Abstract
The term 'agitation' describes a syndrome of excessive motor activity, usually nonpurposeful and associated with internal tension. For intensivists, agitation is not so much a diagnosis, but a consequence of more fundamental etiologies that, when expressed, result in disquietude. Agitation is important in the intensive care unit (ICU) because it can alter the diagnosis and course of medical treatment. It can cloud the etiology of underlying disease processes like a smoke screen, making effective diagnosis difficult or impossible. It may result in the inability of the patient to cooperate with monitoring and therapeutics that requires them to lie relatively still and quiet. Treatment of agitation without considering underlying causation gives the false impression of wellness when in reality end-organ damage is occurring either as a result of agitation itself, or as a result of exacerbation of underlying pathology. Prior to the technological revolution in critical care medicine, agitation was a relatively minor issue. Little could be done for critically ill patients but make them as comfortable as possible and observe them for treatable decompensations. Modern ICUs now have the potential to return critically ill patients to productivity using technological advances in monitoring and closely titrated care, effectively pinning the patient firmly to the bed with tubes and appliances. As a result of our high-tech hemodynamic monitoring and support devices, we have conferred upon the already hemodynamically unstable patient new kinds of stress we never had to deal with before, and simplistic, symptomatic 'shotgun' sedation no longer applies.
Highlights
The term ‘agitation’ describes a syndrome of excessive motor activity, usually nonpurposeful and associated with internal tension
Agitation is important in the intensive care unit (ICU) because it can alter the diagnosis and course of medical treatment
It can cloud the etiology of underlying disease processes like a smoke screen, making effective diagnosis difficult or impossible
Summary
The term ‘agitation’ describes a syndrome of excessive motor activity, usually nonpurposeful and associated with internal tension. Clinical implications of neurotransmission and agitation in the ICU The acute behavioral responses brought about by the activation of neurotransmission-modulated humoral responses by psychological and physical trauma represent evolutionary adaptive responses critical for survival in an uncertain and potentially dangerous environment These compensatory responses were presumably created at a time in the universe when there were no high-tech surrogates for naturally induced environmental stress. Significantly higher apparent number of CCK receptors and affinity constants were found in the series of suicide victims The results of this investigation suggest that CCKergic neurotransmission is linked to self-destructive behavior, probably through its impact on anxiety and adaptational deficits [111]. It is a useful tool for investigating the pharmacological and physiological roles of CCK-B receptors and has no clinical role as yet
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