Ver el código de «ICU sedation»

==Background==
*Sedation is commonly used for ICU patients
*Agent choice determined by side effect profile and disease process
*Common ICU uses
**Control agitation
**Improve patient-ventilator synchrony
**Decreases O2 consumption
**Decrease intracranial pressure
*For intubated and mechanically ventilated patients who are unable to clearly communicate the source of agitation, analgesia should always be provided first<ref>https://journals.lww.com/ccmjournal/Fulltext/2018/09000/Clinical_Practice_Guidelines_for_the_Prevention.29.aspx</ref>

==Agents==
*[[Propofol]]
*[[Opioids]]
**[[Fentanyl]]
**[[Morphine]]
*[[Benzodiazepines]]
**[[Midazolam]]
**[[Lorazepam]]
*[[Dexmedetomidine]] → useful as adjunct treatment for severe alcohol withdrawal in the ICU; associated with a reduction in short-term alcohol withdrawal symptoms in ICU patients<ref>Beg, M., Fisher, S., Siu, D., Rajan, S., Troxell, L., & Liu, V. X. (2016). Treatment of Alcohol Withdrawal Syndrome with and without Dexmedetomidine. The Permanente journal, 20(2), 49–53. https://doi.org/10.7812/TPP/15-113</ref>
*[[Ketamine]]
*[[Haloperidol]]

==Adverse Effects==
*Drug and dose dependent, but generally include:
**Hypotension
**Respiratory depression
**Withdrawal
**Delirium
**Arrhythmias

==Monitoring of Sedation==
*Several sedation monitoring scales are validated
*Richmond Agitation and Sedation Scale (RASS) most commonly used ([http://ccn.aacnjournals.org/content/23/2/25/T3.large.jpg RASS])
*The [https://doi.org/10.1002/ejp.880 COMFORT scale] is a valid and reliable system for assessing sedation, distress, and pain in nonverbal pediatric patients

==Considerations==
*Lighter sedation associated with shorter ICU stay, decreased time on ventilator<ref>
Jacobi, J., Fraser, G. L., Coursin, D. B., Riker, R. R., Fontaine, D., Wittbrodt, E. T., Chalfin, D. B., Masica, M. F., Bjerke, S. H., Coplin, W. M., Crippen, D. W., Fuchs, B. D., Kelleher, R. M., Marik, P. E., Nasraway, S. A., Murray, M. J., Peruzzi, W. T. and Lumb, P. D. (2002) ‘Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult’, Critical Care Medicine, 30(1), pp. 119–141.</ref>
*Deeper sedation associated with prolonged ICU stay, increased 6 month mortality<ref>Shehabi, Y., Bellomo, R., Reade, M. C., Bailey, M., Bass, F., Howe, B., McArthur, C., Seppelt, I. M., Webb, S. and Weisbrodt, L. (2012) ‘Early Intensive Care Sedation Predicts Long-Term Mortality in Ventilated Critically Ill Patients’, American Journal of Respiratory and Critical Care Medicine, 186(8), pp. 724–731.</ref>
*Dexmedetomidine or propofol sedation may reduce ICU stay, time on ventilator, when compared with benzodiazepines<ref>Fraser, G. L., Devlin, J. W., Worby, C. P., Alhazzani, W., Barr, J., Dasta, J. F., Kress, J. P., Davidson, J. E. and Spencer, F. A. (2013) ‘Benzodiazepine Versus Nonbenzodiazepine-Based Sedation for Mechanically Ventilated, Critically Ill Adults’, Critical Care Medicine, 41pp. 30–38.</ref>
**SCCM Recommendation, level 2B (weak recommendation)<ref>Barr, J., Fraser, G. L., Puntillo, K., Ely, W. E., Gélinas, C., Dasta, J. F., Davidson, J. E., Devlin, J. W., Kress, J. P., Joffe, A. M., Coursin, D. B., Herr, D. L., Tung, A., Robinson, B. R. H., Fontaine, D. K., Ramsay, M. A., Riker, R. R., Sessler, C. N., Pun, B., Skrobik, Y. and Jaeschke, R. (2013) ‘Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit’, Critical Care Medicine, 41(1), pp. 278–280.</ref>

==See Also==
*[[Sedation (main)]]

==References==
<references/>

[[Category:Critical Care]]
[[Category:Pharmacology]]