Sedation for the Mechanically Ventilated Adult ICU Patient

• Critically ill patients experience pain, anxiety, delirium, agitation, and sleep disruption.
• When not adequately managed, pain, anxiety, agitation, and delirium have been associated with both short- and long-term morbidity and mortality.
• The Society of Critical Care Medicine recently convened a panel to update their 2018 guidelines on the management of pain, agitation/sedation, delirium, immobility, and sleep disruption in the adult ICU patient.
• Based on approximately 29 RCTs, the panel updated its 2018 recommendation on sedation in the mechanically ventilated adult patient to suggest that dexmedetomidine be used, over propofol, when light sedation or delirium reduction is the goal.
• Importantly, a primary side effect of dexmedetomidine is bradycardia.
• As a result, the panel recommended alternative agents be considered in patients at high risk of bradycardia or when deep sedation is the goal.

References

Lewis K, et al. Executive summary of a focused update to the clinical practice guidelines for the prevention and management of pain, anxiety, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2025; 53:e701-e710.