The impact of sedation protocols on outcomes in critical illness.

Abstract

Critically ill patients often require pharmacologic sedation to treat pain, agitation, and delirium or to tolerate mechanical ventilation and invasive procedures (1). Over the last several decades, our understanding of medications commonly administered for sedation in the critically ill has increased and we now appreciate both the short and long-term consequences of prolonged exposure to these agents. In fact, the Society of Critical Care Medicine recently revised its sedation guidelines based on emerging evidence that certain sedation practices may influence outcomes in critical illness (2). For example, it has become quite clear that prolonged exposure to benzodiazepines and, to a lesser extent opiates, contributes to the development of delirium, while the use of dexmedetomidine might decrease the risk. However, it would be premature to suggest that we currently know enough to protocolize “optimal” sedation algorithms. Despite this recent interest in dexmedetomidine as a “delirium sparing” sedative-hypnotic, a recent meta-analysis concluded that no definitive conclusions on the use of dexmedetomidine can be drawn yet and more clinical trials seem warranted (3). In any case, delirium is associated with increased mortality, prolonged stay on the intensive care unit (ICU) and the development of post ICU cognitive impairment, and the search for new strategies to prevent or treat delirium is currently an area of intense investigation (4).