Summary and References

Over this dialogue, we outlined key components to develop a comprehensive pharmacist education program on best practices for post-intubation sedation management in critically ill patients.

The course introduction covered background on mechanical ventilation, goals of sedation, and risks of over-sedation. Next, we detailed important concepts for assessing sedation needs including causes of ICU agitation, sedation scales, delirium tools, and bispectral index monitoring.

An extensive chapter on sedative agents provided an overview of analgesics, propofol, dexmedetomidine, and benzodiazepines. Pharmacology, literature summaries, and unique considerations were outlined for each medication class.

Additional chapters focused on evidence-based sedation strategies like lighter sedation, analgesia-first approaches, and coordinated awakening/breathing trials. Tailoring sedation in special populations including the elderly, organ dysfunction, substance withdrawal, and traumatic brain injury was also addressed.

Finally, key recommendations from the 2018 SCCM PADIS guidelines for analgesia, sedation, and delirium were summarized to provide a concise, up-to-date reference on best practices.

References

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• Chanques G, Jaber S, Barbotte E, et al. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med. 2006;34(6):1691-1699.
• Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018;46(9):e825-e873.
• Payen JF, Bru O, Bosson JL, et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med. 2001;29(12):2258-2263.
• Chanques G, Jaber S, Barbotte E, et al. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med. 2006;34(6):1691-1699.
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