Introduction

Mechanical ventilation and endotracheal intubation are often required in critically ill patients to provide respiratory support. However, these interventions can be uncomfortable and distressing for patients. Post-intubation sedation involves the use of pharmacological agents to provide comfort, safety, and ease of mechanical ventilation after intubation.1

The goals of post-intubation sedation include:

• Patient Comfort: Sedation helps relieve anxiety, pain, and discomfort associated with endotracheal tubes, patient-ventilator dyssynchrony, and other aspects of critical illness. This promotes overall patient comfort.2
• Ventilator Synchrony: Sedation can minimize patient agitation, coughing, and respiratory effort against the ventilator. This improves patient-ventilator interaction and synchrony.3
• Reduce Oxygen Demand: Sedation produces physiologic effects that help reduce oxygen consumption and demand. This includes decreasing blood pressure, heart rate, and respiratory drive. This may be beneficial in severe respiratory failure.4

While post-intubation sedation is important for management, overly deep sedation can lead to complications like prolonged mechanical ventilation, weakness, and delirium.5 Light sedation targeted to specific patient needs is generally the preferred approach.6 Careful patient selection, dosing, monitoring, and tapering of sedative medications is required to maximize benefit and minimize risks. This course will review best practices for post-intubation sedation management in critically ill patients.