Agitation in the ICU: part one Anatomical and physiologic basis for the agitated state

Introduction The term ‘agitation’ describes a syndrome of excessive motor activity, usually nonpurposeful and associated with internal tension. For intensivists, agitation is not so much a diagnosis, but a consequence of more fundamental etiologies that, when expressed, result in disquietude. Agitation is important in the intensive care unit (ICU) because it can alter the diagnosis and course of medical treatment. It can cloud the etiology of underlying disease processes like a smoke screen, making effective diagnosis difficult or impossible. It may result in the inability of the patient to cooperate with monitoring and therapeutics that requires them to lie relatively still and quiet. Treatment of agitation without considering underlying causation gives the false impression of wellness when in reality end-organ damage is occurring either as a result of agitation itself, or as a result of exacerbation of underlying pathology.