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Sedatives and anti-anxiety agents in critical illness 

Sedatives and anti-anxiety agents in critical illness
Chapter:
Sedatives and anti-anxiety agents in critical illness
Author(s):

Curtis N. Sessler

and Katie M. Muzevich

DOI:
10.1093/med/9780199600830.003.0042
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date: 21 February 2020

Sedative and anti-anxiety agents are administered to many mechanically-ventilated intensive care unit (ICU) patients. While commonly considered supportive care, suboptimal administration of sedatives has been linked to longer duration of mechanical ventilation and longer ICU length of stay. The use of a structured multidisciplinary approach can help improve outcomes. The level of consciousness, as well as the presence and severity of agitation should be routinely evaluated using a validated sedation–agitation scale. The approach to delivery of sedation should be based upon specific goals, particularly mechanical ventilation, while maintaining the lightest possible level of sedation. Selection should be based upon clinical circumstances and patient characteristics, however, when continuous infusion sedation is required, experts suggest using non-benzodiazepine agents. A variety of strategies for sedation management have been demonstrated to be effective in clinical trials including use of protocols, targeting light sedation, preference of analgesics for initial therapy, use of intermittent, rather than continuous drug delivery when possible, and daily interruption of sedation. Finally, light sedation should be linked to performance of spontaneous breathing trials, as well as early mobilization.

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