Optimum sedation and analgesia in critical illness: we need to keep trying

Gavin G Lavery

doi:10.1186/cc2998

Abstract

Many studies have documented patients' distressing recollections of the intensive care unit (ICU). The study by van de Leur and colleagues, conducted in a group of surgical ICU patients with moderate severity of sickness, found that the frequency of such unpleasant memories was increased in those able to recall factual information about their stay in the ICU. The study did not include sedation scoring but it did use a simple tool to assess factual recall. This tool appeared reliable and could be easily applied in any ICU. Previous work strongly suggests that abolishing memory of ICU by using deep sedation would not be an appropriate response to these findings. Rather, we need to work on strategies that reduce distress by improving analgesia, reducing noxious stimuli (if possible) and, potentially, using pharmacology to produce a calm patient with minimal sedation. Achieving the latter is rarely possible today but it might become possible with future drug development.

Highlights

In a study reported in this issue of Critical Care, van de Leur and colleagues [1] investigated the experience of critical illness and intensive care unit (ICU) support from the patient’s perspective
The relative frequency of hallucinations as a source of ICU discomfort (32%) appears greater than that found by others [2,4], it must be highlighted that this is the percentage in the subset of patients with recollection of the ICU – a stratification not considered by other studies
The finding that young patients have better factual recall and more memory of discomfort may be due in part to a decreased sensitivity to sedation/analgesia relative to older patients

Summary

Introduction

In a study reported in this issue of Critical Care, van de Leur and colleagues [1] investigated the experience of critical illness and intensive care unit (ICU) support from the patient’s perspective. Good factual recall was associated with increased risk for having memories of physical and/or psychological discomfort. The relative frequency of hallucinations as a source of ICU discomfort (32%) appears greater than that found by others [2,4], it must be highlighted that this is the percentage in the subset of patients with recollection of the ICU – a stratification not considered by other studies.

Results

Conclusion