Patients in the intensive care unit (ICU) are given sedation to achieve certain goals, for example, to maintain patient-ventilator synchrony, to provide some level of comfort and decrease agitation, or to prevent unplanned extubation or central line removal. The goal of sedation should drive the method of delivery (intermittent bolus or continuous drip), the choice of medication (half-life considerations), and the scales used to measure the appropriate level of sedation (Richmond Agitation-Sedation Scale, Ramsey Sedation Scale, Riker Sedation-Agitation Scale).
Oversedation prolongs mechanical ventilation time and length of ICU stay. It also increases the patient’s risk for ventilator-associated pneumonia (VAP) and other health care–associated infections. Undersedation may create a risk to patient safety or the effectiveness of medical and nursing interventions.1