"improving intensive care in Scotland"

Sedation and Analgesia in ICU

Why do patients in ICU need sedation and analgesia?

The most common reason is for tolerance of an endotracheal tube. However, studies have found that anxiety, agitation and pain are, "in general", very common in the ICU despite treatment being supported with sedative and analgesic medication. The causes of anxiety/agitation and pain are frequently multi-factorial and may include some of the following:



  • Anxiety from being in an unfamiliar environment, being on a ventilator or being aware of critical illness.
  • Excessive stimulation (e.g. continuous light and noise, suctioning, turning, investigations, observations)
  • Sleep deprivation
  • Difficulty or inability to communicate
  • A feeling of lack of control
  • Medical causes (e.g. hypoxia, hypoglycaemia, hypotension, delirium)
  • Drugs (e.g. sympathomimetics) and drug withdrawal (including alcohol/nicotine)


      • Prolonged immobility
      • Routine nursing care (e.g. washing, dressing changes, suctioning)
      • Monitoring devices (e.g. central lines, arterial lines, urinary catheters)
      • Therapeutic procedures and in-situ devices (e.g. endotracheal tubes, filtration lines, chest/abdominal drains)
      • Tissue trauma (e.g. post-operative)
      • Co-morbidities (e.g. musculoskeletal diseases, neurological conditions, cancer)


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