Sedation and pain management in the ICU

During the past decade, critical care physicians have recognized that routinely maintaining patients in a pharmacological deep stupor or unconsciousness as a consequence of sedation is not beneficial. Data has since emerged to support the concept that more optimal, lower dosing of sedatives with preservation of the wakeful state is important in reducing mortality and shortening the duration of mechanical ventilation and overall intensive care unit (ICU) length of stay (LOS) [1-4]. Such emphasis also aids in supporting patient autonomy and in the prevention of and early intervention for evolving neurological deterioration [5-7]. Such tenets are in keeping with the guidelines from the Society of Critical Care Medicine (SCCM) for patient sedation [8]. More interactive patients require that regular assessments be made to ensure adequacy of comfort and analgesia. Along parallel lines, the US Joint Commission on Accreditation of Healthcare Organizations (JCAHO) introduced in 2000 their mandate for the implementation of standards for pain assessment and treatment in hospitalized patients [9].