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Sedation and Analgesia in ICU

The complications of inadeqaute or excessive sedation

Optimal sedation enables a calm, comfortable patient to safely participate in their care. Both inadequate and excessive sedation and analgesia have complications.

 

Complications of inadequate sedation and analgesia include:

  • Initiating a stress response with the associated increased myocardial oxygen consumption, sustained catabolism, immunosupression and hypercoagulability.
  • Sleep deprivation prolonging recovery.
  • Worsened pulmonary function.
  • Inadvertent removal of indwelling lines and tubes.
  • Ventilator dysynchrony with hypoxaemia and hypercarbia.
  • Failure to comply with and derive benefit from treatments.
  • Anxiety, which has been found to be a predictor of post-traumatic stress disorder (PTSD) in ICU survivors.

 

Complications of excessive sedation and analgesia include:

  • Difficulty with adequately assessing neurological function.
  • Increased duration of mechanical ventilation.
  • Greater cardiovascular depression and/or inotropic/vasopressor requirements.
  • Paradoxical agitation resulting from a disorientated patient being unable to remember where they are or why they are in ICU.
  • Delusional memories and subsequent PTSD, resulting from patients being unable to recall actual events.
  • Increased length of ICU stay.
  • Increased length of hospital stay.
  • Increased cost of ICU care. 

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