In this issue of Critical Care, Dr Haenggi and co-workers present a study evaluating bispectral index (BIS), state entropy (SE) and response entropy in 44 patients sedated in the intensive care unit (ICU). As in recent studies attempting to correlate frontal electroencephalogram (EEG) measurements with clinical evaluations of sedative efficacy, there is considerable overlap in numerical EEG val...

Methods: a literature review from 1990 to August 2012. Introduction: pain and its recognition can be a particular problem for patients in intensive care units (ICUs). Studies have suggested that around 70% of ICU patients have unrecognised or undertreated pain. Pain has serious physical and psychological effects, and can impair patient recovery and discharge. Pain relief is also an ethical and ...

PURPOSE The aim of the study was to characterize the practices of Brazilian ICU physicians toward sedation and delirium. MATERIALS AND METHODS A cross-sectional survey was conducted among a convenience sample of critical care physicians between April and June 2008. RESULTS One thousand fifteen critical care physicians responded. Sedation scoring systems were used by 893 (88.3%) of the respo...

Sedation in the intensive care unit (ICU), long considered a necessary but relatively benign adjunct to patient management, is now recognized as an important determinant of patient morbidity. The implementation of nursedriven sedation protocols that minimize continuous sedative infusions, and daily interruption of infusions to allow patient awakening, have been shown to reduce the duration of m...

CONTEXT Sedation has become an integral part of critical care practice in minimizing patient discomfort; however, sedatives have adverse effects and the potential to prolong mechanical ventilation, which may increase health care costs. OBJECTIVE To determine which form of sedation is associated with optimal sedation, the shortest time to extubation, and length of intensive care unit (ICU) sta...

Objective This paper reviews existing literature on delirium that arises during mechanical ventilation in the Intensive Care Unit (ICU). It looks at the physiology of delirium, its subtypes and risk factors. It further considers the impact of delirium on cognitive and psychosocial function of patients after their discharge from acute care. The aim of this paper was to increase awareness of ICU ...

INTRODUCTION Remifentanil is an opioid with a unique pharmacokinetic profile. Its organ-independent elimination and short context-sensitive half time of 3 to 4 minutes lead to a highly predictable offset of action. We tested the hypothesis that with an analgesia-based sedation regimen with remifentanil and propofol, patients after cardiac surgery reach predefined criteria for discharge from the...

OBJECTIVES To describe the rationale, design and methodology for a trial of three novel interventions developed to improve sedation-analgesia quality in adult intensive care units (ICUs). PARTICIPANTS AND SETTING 8 clusters, each a Scottish ICU. All mechanically ventilated sedated patients were potentially eligible for inclusion in data analysis. DESIGN Cluster randomised design in 8 ICUs, ...

We read with interest the study by Zhou and colleagues because it represents an important effort towards advancing the knowledge in current sedation strategies [1]. However, one crucial issue in sedation trials is to choose clinically relevant and patient-centered endpoints. Recent randomized trials demonstrate that sedation strategies with similar short-term mortality rates and ICU length of s...

BACKGROUND Evaluating depth of sedation in the intensive care unit (ICU) is crucial for the management of mechanically ventilated patients but can be challenging in some situations. Because the depth of hypnosis is correlated with the decrease in photomotor reflex (PMR), we suggest using pupillometric video as an automated, noninvasive, simple, and reproducible technique to evaluate the depth o...