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November 21, 2012

The Changing Landscape of ICU Sedation

Author Affiliations

Author Affiliations: Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois.

JAMA. 2012;308(19):2030-2031. doi:10.1001/jama.2012.48321

Intubation and mechanical ventilation are essential components of modern intensive care. However, they are also uncomfortable and often intolerable for the patient. Therefore, intensive care clinicians typically prescribe sedation for ventilated patients, hoping to ensure comfort and yet avoid excess or prolonged unconsciousness. Two decades ago, the typical approach was to provide sedation via continuous infusion, with a focus on ensuring comfort and with little awareness of the adverse effects of excessive sedative use in the intensive care unit (ICU).1 However, as reports emerged showing such infusions could unnecessarily prolong the duration of mechanical ventilation and intensive care,2 a variety of evidence-based sedation algorithms for mechanically ventilated patients evolved.

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