Sedation in the critically ill patient.

The goal of critical care medicine is to support organ function and maintain homeostasis until healing can occur. Sedation and analgesia may blunt the physiologic and psychologic sequelae of intensive care unit stress, and support homeostasis. Although a wide variety of agents have been used empirically, the recognition of analgesia, amnesia, and hypnosis as discrete elements comprising the sedated state has facilitated an individualized approach to therapy. Because intensive care unit patients are a highly heterogeneous population with varying levels of end-organ compromise, the development of specific, easily titratable, parenteral agents has made intensive care unit sedation safer. A trend toward refining dosage regimens in order to minimize the total dose of drug administered and to reduce the occurrence of residual sedation is driven by utilization and cost concerns. The capability for simple bedside electrophysiologic monitoring of the level of sedation is expected to improve the ability to provide optimal therapy.

Department of Anesthesiology, Division of Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.