The sedation of critically ill adults: part 2: management.
The prevention and treatment of pain, anxiety, and delirium in the ICU are important goals. But achieving a balance between sedation and analgesia, especially in critically ill patients on mechanical ventilation, can be challenging. Both under- and oversedation carry grave risks. Without having an agreed-upon end point for sedation, different providers will likely have disparate treatment goals, increasing the risk of iatrogenic complications and possibly impeding recovery. In 2002 the Society of Critical Care Medicine, along with the American Society of Health-System Pharmacists, updated recommendations in its clinical practice guidelines for the sustained use of sedatives and analgesics in adults. This two-part series examines those recommendations concerning sedation assessment and management, as well as the current literature. Last month, Part 1 reviewed pertinent recommendations concerning pain and delirium and discussed tools for assessing pain, delirium, and sedation. This month, Part 2 explores pharmacologic and nonpharmacologic management of anxiety and agitation in the ICU. The second in a two-part series focuses on the pharmacologic and nonpharmacologic management of anxiety and agitation in the ICU.
Pun
Brenda T
BT
Vanderbilt University Medical Center in Nashville, TN, USA. brenda.pun@vanderbilt.edu
Dunn
Jan
J
D000368:Aged; D000465:Algorithms; D001007:Anxiety / Q000517:prevention & control*; D002985:Clinical Protocols; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods* / Q000451:nursing; D003422:Critical Care / Q000379:methods*; D003663:Decision Trees; D003693:Delirium / Q000517:prevention & control*; D016903:Drug Monitoring / Q000379:methods / Q000451:nursing; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D024802:Nurse's Role; D009730:Nursing Assessment; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods / Q000451:nursing; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011595:Psychomotor Agitation / Q000517:prevention & control; D012121:Respiration, Artificial / Q000009:adverse effects / Q000451:nursing; D012307:Risk Factors