Intensive care sedation: the past, present and the future

Yahya Shehabi,Jukka Takala,Richard Riker,Rinaldo Bellomo,Sangeeta Mehta

doi:10.1186/cc12679

Abstract

Despite the universal prescription of sedative drugs in the intensive care unit (ICU), current practice is not guided by high-level evidence. Landmark sedation trials have made significant contributions to our understanding of the problems associated with ICU sedation and have promoted changes to current practice. We identified challenges and limitations of clinical trials which reduced the generalizability and the universal adoption of key interventions. We present an international perspective regarding current sedation practice and a blueprint for future research, which seeks to avoid known limitations and generate much-needed high-level evidence to better guide clinicians' management and therapeutic choices of sedative agents.

Highlights

Despite the universal prescription of sedative drugs in the intensive care unit (ICU), current practice is not guided by high-level evidence
Expect that there is a strong body of epidemiologic knowledge about the use of such drugs to guide clinicians’ current practice and therapeutic choices
Because of the paucity of ICU-specific data regarding sedation, the first ICU sedation guidelines published in 1995 contained six recommendations and were based on 13 references [8]. This pioneering effort recognized that adequate analgesia was a primary goal, that long-term administration of lorazepam had prolonged clinical effects, and that the greater acquisition costs of new sedatives were potentially balanced by downstream clinical benefits with short-term use

Summary

Introduction

Despite the universal prescription of sedative drugs in the intensive care unit (ICU), current practice is not guided by high-level evidence. Intensive care sedation: past, present, and future The administration of sedative drugs is an almost universal intervention in mechanically ventilated intensive care unit (ICU) patients [1]. Despite many years of benzodiazepines and propofol use, few studies compared these medications [25] and only recently have they been evaluated for safety and efficacy in large randomized controlled trials.

Results

Conclusion