Even while the exact indications for use of anxiolytic drugs in the ICU remain undefined, sedation has become an integral part of critical care to minimize patient discomfort and anxiety, and to attenuate the neuroendocrine stress response. Clinicians strive to reduce the proportion of ICU patients who report fear and anxiety during mechanical ventilation, and virtually always recall this experience as unpleasant. However, our current efforts to provide sedation and comfort may simultaneously produce unintended consequences that prolong the period of mechanical ventilation, predispose patients to nosocomial pneumonia, increase ICU length-of-stay and, therefore, increase hospital costs. Ideally, appropriate sedation allows the patient to remain in a calm but communicative state, and expedites weaning and discontinuation of mechanical ventilation. Sedatives should be periodically reassessed and titrated according to one of many sedation scales available. Intermittent interruption or discontinuation of sedative drug infusions may be warranted to evaluate the underlying neurological responsiveness and respiratory progress of critically ill patients. Newer therapies, such as DEX, may also expedite achieving these goals for future ICU patients. Sedative drug comparisons and appropriate ICU dosing are summarized in Table 6.
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