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.