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  • Print publication year: 2012
  • Online publication date: March 2012

Chapter 18 - Sedation in the intensive care setting

Summary

The incidence of sedation-related complications for procedures is unknown, as mandatory reporting of outcomes is lacking. However, two sources of information are available that can shed light on the risks of sedation encountered in non-operating-room locations. The American Society of Anesthesiologists (ASA) changed the standards for monitoring of ventilation during moderate or deep sedation to require capnography to measure exhaled carbon dioxide unless precluded or invalidated by the nature of the patient, procedure, or equipment. Sedation-induced respiratory depression may cause brain damage and/or death. Brain function monitoring may have a beneficial role for procedural sedation in the future, but requires more investigation. The major controversies in procedural sedation are the choice of sedative agents and the administration of propofol by non-anesthesia providers. Future drugs include potential use of fospropofol and dexmedetomidine for sedation, patient-controlled sedation and analgesia (PCSA), and computer-assisted personalized sedation (CAPS).

Further reading

American Society of Anesthesiologists Task Force on Intraoperative Awareness . Practice advisory for intraoperative awareness and brain function monitoring: a report by the American Society of Anesthesiologists Task Force on Intraoperative Awareness. Anesthesiology 2006; 104: 847–64.
Brush DR , Kress JP . Sedation and analgesia for the mechanically ventilated patient. Clin Chest Med 2009; 30: 131–41.
Carson SS , Kress JP , Rodgers JE , et al. A randomized trial of intermittent lorazepam versus propofol with daily interruption in mechanically ventilated patients. Crit Care Med 2006; 34: 1326–32.
Chanqu, G , Jaber S , Barbotte E , et al. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 2006; 34: 1691–9.
Dasta JF , Kane-Gill SL , Pencina M , et al. A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit. Crit Care Med 2010; 38: 497–503.
Girard TD , Jackson JC , Pandharipande PP , et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 2010; 38: 1513–20.
Jacobi J , Fraser GL , Coursin DB , et al. Task Force of the American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine (SCCM), American Society of Health-System Pharmacists (ASHP), American College of Chest Physicians. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30: 119–41.
Kam PC , Cardone D . Propofol infusion syndrome. Anaesthesia 2007; 62: 690–701.
Olsen ML , Swetz KM , Mueller PS . Ethical decision making with end-of-life care: palliative sedation and withholding or withdrawing life-sustaining treatments. Mayo Clin Proc 2010; 85: 949–54.
Pandharipande PP , Pun BT , Herr DL , et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA 2007; 298: 2644–53.
Rea RS , Battistone S , Fong JJ , Devlin JW. Atypical antipsychotics versus haloperidol for treatment of delirium in acutely ill patients. Pharmacotherapy 2007; 27: 588–94.
Sessler CN , Varney K . Patient-focused sedation and analgesia in the ICU. Chest 2008; 133: 552–65.
Shehabi Y , Riker RR , Bokesch PM , et al. Delirium duration and mortality in lightly sedated mechanically ventilated intensive care patients. Crit Care Med 2010; 38: 2311–18.
Strøm T , Martinussen T , Toft P . A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 2010; 375: 475–80.