Aims of sedation/analgesia

The concept of analgo-sedation in intensive care medicine has changed considerably since the last decades. Deep sedation, keeping patients artificially unconscious, is not necessary anymore, it postpones weaning from mechanical ventilation, it provokes complications, and prolongs the length of ICU stay. On the other hand, recent surveys have shown that patients recall their intensive care experience still as stressing and painful. This need more awareness of patient's pain and the readiness to give analgesics particularly before painful procedures. The frightening environment of the ICU, sleep deprivation, pain and discomfort related not only to the actual dysfunctions, but even more to the stressing procedures of care and treatment, make a certain level of sedation necessary. But patients' discomfort may also originate from many other reasons, such as hypoxaemia, hypotension, cardiac failure, drugs overdose or withdrawal, or simply from an uncomfortable body position. These sometimes non-obvious reasons have to be carefully looked for in order to treat the problem effectively. Delirium and other mental problems are common in critically ill patients. They have to be diagnosed with particular attention and treated specifically. Sedatives must be carefully adapted to the individual needs and the actual situation. Modern modes of mechanical ventilation allows lower levels of sedation. Regularly repeated assessment of the sedation level (e.g. by Ramsay score) is mandatory; a sedation protocol seems advantageous. To avoid inadvertent accumulation and overdose, it is recommended to keep the patient at a sedation level at which communication is still possible. A daily interruption of the sedation has shown to shorten the duration of mechanical ventilation and the length of ICU stay.