Optimal Sedation for the Ventilation of Critically Ill Patients

Michael      C. Reade

Abstract

Analogous to the “triad of anaesthesia” (hypnosis, analgesia and muscle relaxation), analgesia, prevention or control of delirium, and sedation form the ‘triad’ of intensive care pharmacotherapy to facilitate tolerable mechanical ventilation in the critically ill. As in the triad of anaesthesia, agents used primarily for one of these three purposes have additional effects on the other two. In intensive care practice, sedation should therefore not be considered in isolation, but as part of an integrated strategy aimed at minimising patient distress, maximising the efficiency of mechanical ventilation, and facilitating extubation as soon as possible. This review begins by discussing the pharmacology of the agents primarily targeting each component of the ‘triad of intensive care’ , followed by a review of recent research into how these agents should be optimally combined and administered to achieve the best possible patient outcomes.

Keywords: Hypnotics and sedatives, delirium, analgesia, intensive care, respiration, artificial, anaesthesia, sedation, Analgesics, endotracheal intubation, dysphoria, Pethidine, Opioids, Morphine, Fentanyl, Remifentanil, Hypnotics, Midazolam, Lorazepam, Diazepam, Propofol, Alpha Agonists, Clonidine, Dexmedetomidine, propofol infusion syndrome, SEDCOM, haloperidol, Olanzapine, Risperidione, Muscle Relaxants, Agitation, Pain, ventilation