Evaluating Patients for “Light Sedation”

Abstract

Continuous sedative infusion is commonly used along with some form of pain medication for patients receiving mechanical ventilation. Such therapy has multiple goals: managing agitation and delirium, avoiding patient safety issues such as self-extubation, or maintaining patient/ventilator synchrony. However, research has shown us that use of deep sedation for patients in the intensive care unit (ICU) is not innocuous.1 Oversedation contributes to delirium, increases ICU stay, and fosters development of post–intensive care syndrome after discharge. Long-term effects of delirium affect quality of life and the ability to return to pre-ICU life and activities. Although sedation goals based on validated scales (eg, Sedation-Agitation Scale, Richmond Agitation-Sedation Scale) have been recommended in the guidelines, no measurable target has been determined to be “light sedation.” The purpose of the accompanying study by Brown et al was to determine what the best numerical targets are on the validated scales to achieve light sedation, defined as the patient being able to follow 3 specific commands. Even though this study requires replication, it does take us one step closer to achieving true light sedation and supporting high-quality outcomes for our ICU patients.