Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients
The clinical approach to sedation in critically ill patients has changed dramatically over the last two decades, moving to a regimen of light or non-sedation associated with adequate analgesia to guarantee the patient’s comfort, active interaction with the environment and family, and early mobilizat...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.901343/full |
| _version_ | 1828833452445663232 |
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| author | Nicola Gitti Stefania Renzi Mattia Marchesi Michele Bertoni Francisco A. Lobo Frank A. Rasulo Frank A. Rasulo Alberto Goffi Matteo Pozzi Simone Piva Simone Piva |
| author_facet | Nicola Gitti Stefania Renzi Mattia Marchesi Michele Bertoni Francisco A. Lobo Frank A. Rasulo Frank A. Rasulo Alberto Goffi Matteo Pozzi Simone Piva Simone Piva |
| author_sort | Nicola Gitti |
| collection | DOAJ |
| description | The clinical approach to sedation in critically ill patients has changed dramatically over the last two decades, moving to a regimen of light or non-sedation associated with adequate analgesia to guarantee the patient’s comfort, active interaction with the environment and family, and early mobilization and assessment of delirium. Although deep sedation (DS) may still be necessary for certain clinical scenarios, it should be limited to strict indications, such as mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS), status epilepticus, intracranial hypertension, or those requiring target temperature management. DS, if not indicated, is associated with prolonged duration of mechanical ventilation and ICU stay, and increased mortality. Therefore, continuous monitoring of the level of sedation, especially when associated with the raw EEG data, is important to avoid unnecessary oversedation and to convert a DS strategy to light sedation as soon as possible. The approach to the management of critically ill patients is multidimensional, so targeted sedation should be considered in the context of the ABCDEF bundle, a holistic patient approach. Sedation may interfere with early mobilization and family engagement and may have an impact on delirium assessment and risk. If adequately applied, the ABCDEF bundle allows for a patient-centered, multidimensional, and multi-professional ICU care model to be achieved, with a positive impact on appropriate sedation and patient comfort, along with other important determinants of long-term patient outcomes. |
| first_indexed | 2024-12-12T17:19:09Z |
| format | Article |
| id | doaj.art-0fed2d1e1273412a87978eecf27b7945 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-12T17:19:09Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-0fed2d1e1273412a87978eecf27b79452022-12-22T00:17:42ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-06-01910.3389/fmed.2022.901343901343Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill PatientsNicola Gitti0Stefania Renzi1Mattia Marchesi2Michele Bertoni3Francisco A. Lobo4Frank A. Rasulo5Frank A. Rasulo6Alberto Goffi7Matteo Pozzi8Simone Piva9Simone Piva10Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, ItalyDepartment of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, ItalyDepartment of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, ItalyDepartment of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, ItalyInstitute of Anesthesiology, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab EmiratesDepartment of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, ItalyDepartment of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, ItalyInterdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, CanadaDepartment of Emergency and Intensive Care, San Gerardo Hospital, Monza, ItalyDepartment of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, ItalyDepartment of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, ItalyThe clinical approach to sedation in critically ill patients has changed dramatically over the last two decades, moving to a regimen of light or non-sedation associated with adequate analgesia to guarantee the patient’s comfort, active interaction with the environment and family, and early mobilization and assessment of delirium. Although deep sedation (DS) may still be necessary for certain clinical scenarios, it should be limited to strict indications, such as mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS), status epilepticus, intracranial hypertension, or those requiring target temperature management. DS, if not indicated, is associated with prolonged duration of mechanical ventilation and ICU stay, and increased mortality. Therefore, continuous monitoring of the level of sedation, especially when associated with the raw EEG data, is important to avoid unnecessary oversedation and to convert a DS strategy to light sedation as soon as possible. The approach to the management of critically ill patients is multidimensional, so targeted sedation should be considered in the context of the ABCDEF bundle, a holistic patient approach. Sedation may interfere with early mobilization and family engagement and may have an impact on delirium assessment and risk. If adequately applied, the ABCDEF bundle allows for a patient-centered, multidimensional, and multi-professional ICU care model to be achieved, with a positive impact on appropriate sedation and patient comfort, along with other important determinants of long-term patient outcomes.https://www.frontiersin.org/articles/10.3389/fmed.2022.901343/fullICU—intensive care unitneuromonitoringlight sedationdexmedetomedinepropofol |
| spellingShingle | Nicola Gitti Stefania Renzi Mattia Marchesi Michele Bertoni Francisco A. Lobo Frank A. Rasulo Frank A. Rasulo Alberto Goffi Matteo Pozzi Simone Piva Simone Piva Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients Frontiers in Medicine ICU—intensive care unit neuromonitoring light sedation dexmedetomedine propofol |
| title | Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients |
| title_full | Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients |
| title_fullStr | Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients |
| title_full_unstemmed | Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients |
| title_short | Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients |
| title_sort | seeking the light in intensive care unit sedation the optimal sedation strategy for critically ill patients |
| topic | ICU—intensive care unit neuromonitoring light sedation dexmedetomedine propofol |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.901343/full |
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