Out with the old or better use of the old? A quest in sedation

摘要

Most mechanically ventilated critically ill patients need to be given sedative drugs to enable effective ventilation, to obtund adverse effects of the sympathetic response, and for the obvious humane reason to avoid distress. Effective analgesia and reassurance are helpful and should be used, but they are generally not sufficient. Sedative drugs do not specifically treat or support a patient during critical illness and indeed have potential to cause harm if used inappropriately (1). A fundamental problem exists that individual patient requirements, which can differ radically, are dependent on a number of factors that cannot be readily predicted or modified. The current evidence base still leaves many unanswered questions or gives conflicting answers regarding the choice of drugs, whether administration should be as an infusion or intermittent bolus (2, 3), how the response should be monitored (4), and the need for routine sedation breaks (5,6).