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Advancing Sedation Strategies to Improve Clinical Outcomes in Ventilated Critically Ill Patients

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Annual Update in Intensive Care and Emergency Medicine 2023

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

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Abstract

Sedation strategies in mechanically ventilated critically ill patients have evolved over the last 20 years following pioneering concepts, such as daily sedative interruption, and comparative trials evaluating benzodiazepines alternatives, such as propofol and dexmedetomidine. The coronavirus disease 2019 (COVID-19) pandemic has been a significant challenge for implementing the one size fits all approach of Clinical Practice Guidelines for the management of pain, sedation/agitation, and delirium. The imperative to rethink and critically appraise these concepts is never stronger. Popular concepts, largely based on single center trials and conducted when the use of benzodiazepines was common, such as light sedation, sedative interruption, analog- or no sedation and early mobilization failed the test of multicenter trials. These trials did not deliver expected benefits, such as reduced ventilation time and delirium; thus, these concepts appear outdated and not feasible or practical in a new era where benzodiazepine alternatives are commonly used. A different approach to sedation management is therefore needed. Sedation trials that have evaluated cotemporary practice of sedation using commonly used sedatives, such as propofol and dexmedetomidine, have provided unparalleled insight into different populations of mechanically ventilated critically ill patients. Age appropriate, dichotomized at 65 years, sedative choice appears to be different and may impact 90-day mortality, ventilation, and delirium free days. Similarly, sedation strategies are likely to impact clinically important outcomes differently in surgical vs. non-surgical patients and in septic vs. non-septic patients, an effect that is impacted by illness severity and age. Investigating contemporary sedation strategies in specific populations of critical illness, including the search for new sedatives is warranted.

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Author information

Authors and Affiliations

  1. School of Clinical Sciences, Monash University, Clayton, VIC, Australia

    Y. Shehabi, W. Al-Bassam & D. Antognini

  2. Monash Health – Monash Medical Centre, Clayton, VIC, Australia

    Y. Shehabi, W. Al-Bassam & D. Antognini

  3. School of Clinical Medicine, University New South Wales and Prince of Wales Hospitals, Sydney, Australia

    Y. Shehabi

  4. School of Medicine, University of Queensland, Brisbane, QLD, Australia

    D. Antognini

Authors
  1. Y. Shehabi
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  2. W. Al-Bassam
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Correspondence to Y. Shehabi .

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Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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Shehabi, Y., Al-Bassam, W., Antognini, D. (2023). Advancing Sedation Strategies to Improve Clinical Outcomes in Ventilated Critically Ill Patients. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2023. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-23005-9_17

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  • DOI: https://doi.org/10.1007/978-3-031-23005-9_17

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  • Online ISBN: 978-3-031-23005-9

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