Optimizing sedation and analgesia in mechanically ventilated patients--an evidence-based approach

Critically ill, mechanically ventilated patients experience pain and anxiety related to a number of factors, including underlying disease processes, invasive procedures, therapeutic devices, immobility, and even routine nursing care such as turning and positioning. Failure to provide adequate analgesia and sedation has been shown to have detrimental physiological consequences, including an increase in sympathetic nervous activity and ventilator dyssynchrony (Young, Knudsen, Hilton & Reves, 2000). Over-sedation has also given rise to concerns related to prolongation of mechanical ventilation, intensive care unit (ICU) length of stay, and cost. The challenge for the ICU team is to provide comfort while avoiding the consequences of both over- and under-sedation. New strategies show promise and focus on a team approach for the management of sedation and analgesia in critically ill, mechanically ventilated patients. These strategies include the use of sedation protocols, which incorporate nurse-driven dose titration directives, sedation scoring systems, and daily interruption of sedative infusions. This article provides a review of three recent studies evaluating these new approaches to the administration of sedation and analgesia in the adult ICU.