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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
Sedation in the neurologic intensive care unit
1Department of Anesthesiology, Mayo Clinic, Charlton 1145, 200 First Street SW, Rochester, MN 55905, USA. keegan.mark@mayo.edu.
Current Treatment Options in Neurology
|March 13, 2008
Summary
Effective neurologic intensive care unit (ICU) sedation requires clear goals, accurate assessment, and tailored drug selection. Protocols improve adherence to evidence-based practices for better patient outcomes.
Area of Science:
- Neurology
- Critical Care Medicine
- Pharmacology
Background:
- Sedation management is critical in the neurologic intensive care unit (ICU).
- Inadequate sedation can negatively impact long-term patient outcomes.
- Delirium, anxiety, and pain require separate identification and treatment.
Purpose of the Study:
- To outline the essential components for adequate sedation in the neurologic ICU.
- To discuss the role of protocols in optimizing sedation management.
- To review appropriate pharmacologic agents for sedation, anxiolysis, and analgesia.
Main Methods:
- Review of current evidence-based recommendations for sedation in neurologic ICUs.
- Discussion of pharmacologic agents including propofol, dexmedetomidine, benzodiazepines, neuroleptics, and opiates.
- Consideration of specific patient populations with acute brain disease.
Main Results:
- Adequate sedation hinges on setting proper goals, assessing sedation levels, and choosing drugs based on patient physiology.
- Protocols enhance compliance with evidence-based sedation guidelines.
- Specific agents are recommended for different indications: propofol/dexmedetomidine for titration, benzodiazepines for anxiety, neuroleptics for delirium, and opiates for pain.
Conclusions:
- Tailoring sedative regimens to individual patient physiology and specific conditions like elevated intracranial pressure is crucial.
- While processed EEG and volatile anesthetics are not currently recommended, other strategies can optimize neurologic ICU sedation.
- Effective sedation management is integral to improving outcomes for critically ill neurologic patients.
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