"improving intensive care in Scotland"

Sedation and Analgesia in ICU

Sedation breaks and withdrawal syndromes


Sedation breaks (holidays):

  • Involve the daily stopping of continuous sedative and analgesic infusions.

  • Once the patient awakens or is uncomfortable sedation/analgesia is recommenced at a lower rate (e.g. half) with further titration of sedatives/analgesics to a targeted sedation score.

  • Are performed safely as long as patients are appropriately monitored by nursing and medical staff for awakening and there is timely resumption of sedation/analgesia where appropriate.

  • Are contraindicated in patients under neuromuscular blockade and where fluctuations in blood pressure and oxygen consumption may be detrimental, e.g. neuro-ICU, traumatic brain injuries and heart failure with critical ventricular function.

  • Have been found to reduce the duration of mechanical ventilation, ICU stay and the number of investigations performed to explain prolonged coma following withdrawal of sedation.


Withdrawal syndromes

  • Withdrawal syndromes can occur with most sedatives and all opioids.

  • Patients at risk:

    • Those who have been in ICU for more than 7 days

    • Those on high sedative/analgesic doses

  • Management includes:

    • The gradual tapering of doses

    • Consideration of conversion to longer acting agents

    • Consideration of the use of clonidine to control symptoms


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