Critically ill patients are routinely provided
analgesia and sedation to prevent
pain and anxiety, permit invasive procedures, reduce stress and oxygen consumption, and improve synchrony with
mechanical ventilation. Regional preferences, patient history, institutional bias, and individual patient and practitioner variability, however, create a wide discrepancy in the approach to sedation of
critically ill patients. Untreated
pain and agitation increase the sympathetic stress response, potentially leading to negative acute and long-term consequences. Oversedation, however, occurs commonly and is associated with worse clinical outcomes, including longer time on
mechanical ventilation, prolonged stay in the intensive care unit, and increased brain dysfunction (
delirium and
coma). Modifying sedation delivery by incorporating
analgesia and sedation protocols, targeted arousal goals, daily interruption of sedation, linked spontaneous awakening and breathing trials, and
early mobilization of patients have all been associated with improvements in patient outcomes and should be incorporated into the clinical management of
critically ill patients. To improve outcomes, including time on
mechanical ventilation and development of acute brain dysfunction, conventional sedation paradigms should be altered by providing necessary
analgesia, incorporating
propofol or
dexmedetomidine to reach arousal targets, and reducing
benzodiazepine exposure.