title: Limiting sedation for patients with acute respiratory distress syndrome - time to wake up.
abstract: OBJECTIVE
  Critically ill patients with acute respiratory distress syndrome (ARDS) may require sedation in their clinical care. The goals of sedation in ARDS patients are to improve patient comfort and tolerance of supportive and therapeutic measures without contributing to adverse outcomes. This review discusses the current evidence for sedation management in patients with ARDS.
  
  
  RESULTS
  Deep sedation strategies should be avoided in the care of patients with ARDS because deep sedation has been associated with increased time on mechanical ventilation, longer ICU and hospital length of stay, and higher mortality in critically ill patients. Adoption of protocol-based, light-sedation strategies is preferred and improves patient outcomes. Although the optimal sedative agent for ARDS patients is unclear, benzodiazepines should be avoided because of associations with oversedation, delirium, prolonged ICU and hospital length of stay, and increased mortality. Minimizing sedation in patients with ARDS facilitates early mobilization and early discharge from the ICU, potentially aiding in recovery from critical illness. Strategies to optimize ventilation in ARDS patients, such as low tidal volume ventilation and high positive end-expiratory pressure can be employed without deep sedation; however, deep sedation is required if patients receive neuromuscular blockade, which may benefit some ARDS patients. Knowledge gaps persist as to whether or not prone positioning and extracorporeal membrane oxygenation can be tolerated with light sedation.
  
  
  CONCLUSIONS
  Current evidence supports the use of protocol-based, light-sedation strategies in critically ill patients with ARDS. Further research into sedation management specifically in ARDS populations is needed.
authors.affiliation: aDivision of Pulmonary, Allergy, and Critical Care Medicine bDepartment of Critical Care Medicine, CRISMA Center, University of Pittsburgh cVA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
authors.forename: Faraaz Ali
authors.initials: FA
authors.lastname: Shah
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Girard
authors.forename: Sachin
authors.initials: S
authors.lastname: Yende
mesh_terms: D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000628:therapy*; D013990:Tidal Volume; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives