Liberating ICU Patients from Deep Sedation and Mechanical Ventilation— An Overview of Best Practices

Pain, agitation, and delirium (PAD) occur frequently in critically ill patients. Severe pain is the most common memory that patients recall of their ICU stay. Pain often goes unrecognized and untreated, because many ICU patients can’t self-report their pain. Severe pain leads to both shortand long-term psychological and physical complications in ICU patients. Agitation and anxiety (due to pain, delirium, drug withdrawal, etc.) also occur often in critically ill patients, leading to hemodynamic instability, ventilator dyssynchrony, and device removal. Delirium occurs in the vast majority of ICU patients at some point during their ICU stay and is a risk factor for prolonged mechanical ventilation, increased ICU and hospital lengths of stay (LOS), increased healthcare costs, and increased hospital mortality in these patients. Delirious ICU patients also have a greater risk of developing long-term cognitive and physical dysfunction, a greater need for institutional care, and a shorter life expectancy following hospital discharge. Delirium can have a widely variable presentation, making it difficult to diagnose in these patients.