- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Chapter 42 Sedatives and anti-anxiety agents in critical illness
- Chapter 43 Analgesics in critical illness
- Chapter 44 Antidepressants in critical illness
- Chapter 45 Antiseizure agents in critical illness
- Chapter 46 Inhalational anaesthetic agents in critical illness
- Chapter 47 Muscle relaxants in critical illness
- Chapter 48 Neuroprotective agents in critical illness
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 184) Nervous system drugs
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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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Part 2.1 Respiratory drugs
- Part 2.2 Cardiovascular drugs
- Part 2.3 Gastrointestinal drugs
- Part 2.4 Nervous system drugs
- Chapter 42 Sedatives and anti-anxiety agents in critical illness
- Chapter 43 Analgesics in critical illness
- Chapter 44 Antidepressants in critical illness
- Chapter 45 Antiseizure agents in critical illness
- Chapter 46 Inhalational anaesthetic agents in critical illness
- Chapter 47 Muscle relaxants in critical illness
- Chapter 48 Neuroprotective agents in critical illness
- Part 2.5 Hormonal drugs
- Part 2.6 Haematological drugs
- Part 2.7 Antimicrobial and immunological drugs
- Part 2.8 Fluids and diuretics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care