Unexplored Territories IN this issue of ANESTHESIOLOGY, Barr et al. make a useful contribution to our understanding of the clinical pharmacology of intensive care unit (ICU) sedation. It is estimated that approximately $1 billion is spent each year in the United States alone on drugs used for sedation in the ICU. Misuse of these drugs contributes to morbidity, mortality, and expense. Optimizati...

HYPOTHESIS The use of weaning and sedation protocols affects the intensive care unit (ICU) course of a trauma population. DESIGN Nonrandomized before-after trial. SETTING A level I trauma center. PATIENTS Three hundred twenty-eight consecutive trauma patients receiving mechanical ventilation treated in the ICU between October 1, 1997, and November 1, 1999. INTERVENTION Sedation and wean...

Sedation in the intensive care unit (ICU) is a topic that has been frequently researched, and debate still exists as to what are the best sedative agents for critically ill patients. There is increasing interest in sleep and circadian rhythm disturbances in the ICU and how they may impact on outcomes. In addition to patient-related and ICU environmental factors that likely impact sleep and circ...

In 1998, Thomas L. Petty expressed his concern about deep sedation and suggested a new link between sedation and severe complications.(1) His phrasing emphasized that it is not the underlying disease, but the physicians themselves that cause the gloomy situation he experienced in his intensive care unit (ICU). As more evidence supporting his theory has emerged, Petty’s editorial seems even more...

BACKGROUND Benzodiazepines, such as lorazepam and midazolam, are frequently administered to surgical intensive care unit (ICU) patients for postoperative sedation. To date, the pharmacology of lorazepam in critically ill patients has not been described. The aim of the current study was to characterize and compare the pharmacokinetics and pharmacodynamics of lorazepam and midazolam administered ...

CONTEXT Gamma-aminobutyric acid receptor agonist medications are the most commonly used sedatives for intensive care unit (ICU) patients, yet preliminary evidence indicates that the alpha(2) agonist dexmedetomidine may have distinct advantages. OBJECTIVE To compare the efficacy and safety of prolonged sedation with dexmedetomidine vs midazolam for mechanically ventilated patients. DESIGN, S...

PURPOSE The aim of this study was to compare the correlation between bispectral index (BIS) monitor and four commonly used subjective clinical scales (Ramsay Sedation Scale (RSS), Richmond Agitation Sedation Scale (RASS), Sedation Agitation Scale, Adaptation to Intensive Care Environment scale) in mechanically ventilated patients in intensive care unit (ICU). In addition, comparison of responsi...

BACKGROUND Poor sleep is common in the ICU setting and may represent a modifiable risk factor for patient participation in ICU-based physical therapy (PT) interventions. This study evaluates the association of perceived sleep quality, delirium, sedation, and other clinically important patient and ICU factors with participation in physical therapy (PT) interventions. METHOD This was a secondar...

OBJECTIVES To evaluate the effects of propofol-based and dexmedetomidine-based sedation regimens on achieving early extubation, length of stay (LOS), intensive care length of stay (ICU-LOS), total hospital costs, and mortality rates in cardiac surgery patients. DESIGN Twenty-three-month retrospective analysis. SETTING Single center, 907 bed community teaching hospital. PARTICIPANTS Five h...