Sédation en réanimation de l'adulte

Abstract

Sedation in ICU refers to the use of pharmacological or non-pharmacological means, aimed at decreasing the anxiety, ensuring a satisfactory analgesia, minimizing the pain and facilitating airway control and mechanical ventilation. The pharmacological procedure generally depends on the drugs used in anaesthesia. Currently, these drugs are also frequently used in the emergency medicine context and in in- and out-hospital intensive care units. The use of these drugs requires a perfect knowledge of their advantages and disadvantages. Indeed, in ICU, their use is more delicate than in anaesthesia (patients with multiple organ failure, haemodynamic consequences, medical history which is sometimes unknown, etc). The objectives of analgesia and sedation in reanimation, the indications, means and methods of administration have been recalled in a consensus conference as well as in clinical practice recommendations addressed by expert societies. However it remains necessary to adopt an institutional strategy and treat the patient on an individual basis to define the duration, to select the drugs and to determine the degree of sedation. The multi-daily assessment and regular interruption of the administration of the drugs enable a clinical examination of the patient and the closest adaptation to his needs by limiting the side effects. Finally, not all sedations are identical regarding causal or associated diseases. Beyond the simple "auxiliary" sedation, new sedative agents appear to play a specific therapeutic role, hence the term « therapeutic sedation ».