Depression and Sedation

36TH CRITICAL CARE CONGRESS:  DEPRESSION IN THE ICU: DOES IT AFFECT OUTCOMES?

Craig Weinert, MD, discusses the factors used to recognize depression in the intubated, mechanically ventilated patient.  The discussion focuses not only on symptoms commonly used to diagnosis depression, but also on pre-existing and environmental factors that may contribute to an ICU patient’s depression.  Dorrie K. Fontaine, RN, PhD, FAAN, discusses the effects of sleep deprivation on patients in the ICU, their length of stay, and quality of care.  She reviews the various factors that cause sleep deprivation leading to depression. 

To hear the complete presentation, click here.

Guidelines

Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.

Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: Use of restraining therapies.

Publications


Critical Care Sedation and Analgesia:  Balancing Comfort and Chemical Restraint Against Delirium and Long-Term Neurocognitive Dysfunction in the Intensive Care Unit.  11th Critical Care Refresher 2007.


It is critically important to realize that the underlying cause of agitation may be highly variable among individual patients in the intensive care unit (ICU); in addition, each patient may have more than one cause for agitation.  Patients who present to the ICU following trauma clearly require analgesia; nonetheless, analgesia is also important to control the cough reflex associated with a foreign body in the trachea, positional pain, and procedural pain.  Anxiolysis is extremely important to treat pre-existing anxiety disorders, substance abuse withdrawal, and the uncertainties and stress associated with life-threatening illness.  Therefore, patients require not only an appropriate dose, at appropriate intervals, for a patient-specific duration, but they also may require additional or adjunctive medications for individualized care. The ideal ICU sedative might be described as one with rapid onset, easy type titratability, minimal side effects, low cost, and rapid and predictable elimination despite end-organ dysfunction.  Thus, sedatives, like many of the other agents used for acute intervention in the ICU, should conform to the tight therapeutic decision loop of assessment–intervention–reassessment. 

Click here to view the entire chapter of Critical Care Sedation and Analgesia:  Balancing Comfort and Chemical Restraint Against Delirium and Long-Term Neurocognitive Dysfunction in the Intensive Care Unit. 

For more information on caring for the critically ill and injured patients, the publication, 11th Critical Care Refresher is available for purchase from the Society of Critical Care Medicine.  Click here for details or to add to your shopping cart.


Critical Connections Articles

Sedation and Delirium: Current Concepts in 2007
June 2007, Critical Connections

Developing and Implementing a Successful ICU Sedation Protocol:
One Hospital's Strategy 
December 2007, Critical Connections

Making the ICU More Humane: A Roadmap for the Future
December 2007, Critical Connections