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March 21, 2012

Weighing the Costs and Benefits of a Sedative

Author Affiliations

Author Affiliations: Department of Anesthesiology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.

JAMA. 2012;307(11):1195-1197. doi:10.1001/jama.2012.319

Critically ill patients traditionally were heavily sedated for safety and to mitigate pain, anxiety, and agitation in the intensive care unit (ICU). But the approach to sedation has shifted with the recognition that heavy sedation may impede care goals such as ventilator weaning and mobilization.1,2 A related concern is that standard sedatives may contribute to delirium, which hinders patient care, increases length of stay, and is associated with increased mortality.3 Many approaches are used to decrease the amount of sedation given, including daily interruptions of sedation to reassess a patient, protocols to target sedation to a prespecified level, emphasis on analgesia first, and a change from default sedation for mechanically ventilated patients to individual assessment of need for sedation.4