Critical care clinics
-
Despite considerable information on the pharmacotherapy of sedation in the ICU, there is little published on the pharmacoeconomics of sedation in patients who are critically ill. The purpose of this article is to discuss the various components that contribute to the cost of treating the agitated ICU patient and to critically review the articles published since 2000 that evaluated costs and cost-effectiveness in ICU patients receiving drugs for agitation and/or pain. Clinicians should look beyond the acquisition cost of a sedative and include the effect of sedatives on the cost of care when selecting the most appropriate sedative.
-
Critical care clinics · Jul 2009
ReviewCurrent sedation practices: lessons learned from international surveys.
Patient outcomes are significantly influenced by the choice of sedative and analgesic agents, the presence of over- or undersedation, poor pain control, and delirium. Individualized sedation management using sedation assessment tools, sedation protocols, and daily sedative interruption can improve clinical outcomes. ⋯ Surveys of clinicians' self-reported practice and prospective practice audits characterize sedation and analgesia practices and provide directions for education and future research. The objective of this review is to present the findings of surveys and practice audits, evaluating the management of sedation and analgesia in mechanically ventilated adults in the intensive care unit, and to summarize international critical care sedation practices.
-
The management of critically ill patients necessitates the use of sedatives and analgesics to provide patient comfort and cooperation. These drugs exert profound effects on all organ systems, not only the central nervous system, and this article describes the immunologic effects of the commonly used critical care sedatives: propofol, the benzodiazepines, opioids, and alpha(2)-adrenoceptor agonists. Benzodiazepines, opioids, and possibly even propofol worsen outcome in animal models of infection, whereas preliminary evidence suggests that the alpha(2)-adrenoceptor agonist, dexmedetomidine, may improve outcomes in the setting of infection. Given the burden of sepsis and secondary infections in critical care, choice of sedation may need to be carefully considered to preserve immune responses in critically ill patients.