15. ICU Sedation

Question 1

Why is sedation important

Answer 1

Most require some form for comfort during stay

Some countries
PRICE - restraint is bad

Under sedation

• Discomfort
• Loss ETT / Vascular access
• poor outcome

Over sedation

• bp
• undetected delirium
• prolong vent & ICU stay
• Ileus
• immobility
• neuropathy / myopathy

Long term PTD

Balanced approach

Daily sedation hold
- reduces vent time

Propofol
Kids
- fatal metabolic acidosis

Question 2

Sedation scoring

Answer 2

Assessment depth to meet objective

• comfort
• pain control
• Facilitate nursing
• sleep
• avoidance adverse outcome ptsd

No consensus

validation problem - lack objective standard

Choose scale
Ease
familiarity
consistent / standardised
usability in tandem

RAAS

Question 3

Optimal sedation

Answer 3

Best evidence methods
sedating patinet approp - not over under

Aspecs
Analgosedation no hypnotic
holding
reduced imaging - slow waking
reduce ventilator & icu time
Rehab D1 prevent weakness
Reduce psycholog prob ptsd

Scoring enough awake enough to assess delirium