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Editorials |

Sedation Scales in the ICU

Curtis N. Sessler, MD, FCCP
Author and Funding Information

Affiliations: Richmond, VA
 ,  Dr. Sessler is the Muren Distinguished Professor of Internal Medicine, Medical Director of Critical Care, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University Health System.

Correspondence to: Curtis N. Sessler, MD, FCCP, Box 980050, Richmond, VA 23298; e-mail: Csessler@hsc.vcu.edu



Chest. 2004;126(6):1727-1730. doi:10.1378/chest.126.6.1727
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Many of the millions of ICU patients undergoing mechanical ventilation worldwide receive sedative and analgesic medications during their hospitalization.24 The principle goals of these interventions are to provide comfort and minimize pain, suffering, anxiety, and other forms of distress, some of which are the result of ICU interventions.5 Clinicians strive to optimize management by recognizing and treating underlying conditions, using nonpharmacologic techniques, selecting the best medication(s) for that individual patient, and administering the lowest effective dose for the shortest possible time.68 Yet, the medications are imperfect, potentially causing unwanted effects, including idiosyncratic or dose-related side effects, as well as problems related to the immobility and loss of protective reflexes that accompanies deep sedation.68 Additionally, persistent or excessive drug-induced sedation, particularly accompanying the “cruise control” of continuous infusion, may prolong hospitalization and thus expose the patient to further risks such as added testing, tracheostomy, and ICU complications.913

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