Current Issue December 2011 | Vol. 29, No. 4
Current Topic
December 2011
Sedation and Analgesia in the ICU: Pharmacology, Protocolization, and Clinical ConsequencesPratik P. Pandharipande, MD, MSCI, and E. Wesley Ely, MD, MPH, Guest Editors
Anyone who has been privileged enough to care for the critically ill over the past 15 years can speak of the rapid evolution of many facets of ICU medicine. Few areas have shifted more than the area of sedation and mechanical ventilation. These inextricably linked components of critical care represent the cornerstones of what we do for patients during their vulnerable course in the ICU. In a nutshell, we have progressed from a culture that embraced nearly universal deep sedation for days on end, with harsh methods of blowing too much air into patients' lungs, to a "kinder and gentler" approach that involves keeping patients much more awake and interactive while delivering much less injurious and smaller puffs of air. Although data from sepsis studies indicate, without a doubt, that early delivery of resuscitation, antibiotics, and other forms of interdisciplinary care are paramount during the first 24 hours to 48 hours of ICU care, a pivotal concept that captures what has changed about sedation and mechanical ventilation is that the timing of their removal (formerly referred to as "weaning," but this term describes a process that is too slow for many patients) turns out to have a very large influence on improving length of stay, cost of care, and complication rates. In short, for sedation and mechanical ventilation, less is more.
September 2011 June 2011 March 20112011 - Volume 29
Information Technology Applied to AnesthesiologySachin Kheterpal, MD, MBA, and Kevin K. Tremper, MD, PhD, Guest Editors
Regional Analgesia and Acute Pain ManagementSugantha Ganapathy, MBBS, DA, FRCA, FFARCS (I), FRCPC, and Vincent Chan, MD, FRCPC, Guest Editors
Quality of Anesthesia CareMark D. Neuman, MD, MSc Elizabeth A. Martinez, MD, MHS, Guest Editors
