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February 4, 2009

A New Era for Sedation in ICU Patients

Author Affiliations

Author Affiliations: Department of Anesthesiology, Columbia University, New York, New York (Dr Wunsch); Department of Medicine, University of Chicago, Chicago, Illinois (Dr Kress).

JAMA. 2009;301(5):542-544. doi:10.1001/jama.2009.24

Critically ill patients frequently require invasive monitoring and other support that can lead to anxiety, agitation, and pain.1 Use of sedation is essential for the comfort and safety of these patients. Options for sedation in the intensive care unit (ICU) are limited, with benzodiazepines and propofol the most common choices.2,3 In the past, these agents were generally used to keep patients motionless and to reduce memory of their experience in the ICU. However, recognition that heavy sedation may increase mortality and morbidity has led to a new model in which the emphasis is on maximizing the comfort of these patients while they remain interactive, oriented, and able to follow instructions.4 This new model relies on strategies such as daily interruptions of sedation,5 use of scores such as the Richmond Agitation-Sedation Scale to maintain target sedation level,6 and minimizing the use of paralytic agents.7

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