Because of variability in individual practices and the potential for institutional bias, discrepancy currently exists in sedation practices for the care of critically ill patients. Such discrepancies have been noted and studied since the 1980s, when a survey was published to highlight the practice of oversedation. Since then, practice has moved toward the use of structured protocols to reach patient-specific endpoints; however, this approach is underused. Inconsistent practice leads to over- and undersedation. Oversedation can prolong the use of mechanical ventilation, increase length of stay, and increase instances of mortality and organ failure in critically ill patients. Undersedation can lead to increased agitation and negative, long-term outcomes in critically ill patients.1,4 

Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit (ICU) suggest that stable sedation is...

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