Sedation and analgesia in the critically ill

Pain management and sedation for critically ill patients remain areas of active interest and debate among intensivists. We review the foundational literature behind practices now considered the standard of care, including a systematic approach to target light sedation as well as the avoidance of benzodiazepine use. These approaches facilitate earlier liberation from mechanical ventilation, shorten intensive care unit length of stay, and reduce delirium. We also discuss the relative merits of dexmedetomidine versus propofol, analgesia-first sedation protocols, emerging medications and areas for future investigation.