In the United States, 55,000 patients are cared for daily in 6000 ICUs.
The most common reason for admission is respiratory failure and the need for mechanical ventilator.
The vast majority of patients on ventilators require sedation
60-80% of ventilated patients develop delirium at some point during their hospital course

Sedation in Ventilated Patients
Mechanical ventilation is uncomfortable and anxiety provoking
Sedation is often necessary for comfort and airway, line, foley, nursing protection
More than 85% of ventilated patients receive sedation
“Standard” sedation
Benzodiazepines - midazolam, lorazepam, diazepam
Anesthetics - propofol

Special circumstance sedation
Central alpha-agonists - clonidine, dexmedetomidine
High-dose opioids
Haloperidol

Sedative Dependence
Patients exposed to more than one week of high dose opioid or sedative may develop tolerance and/or dependence.
Opioid withdrawal:-Pupillary dilation, sweating, lacrimation, rhinorrhea, yawning, tachycardia, irritability, anxiety
Benzodiazepine withdrawal:-Dysphoria, tremor, headache, nausea, sweating, agitation, anxiety, sleep disturbances, myoclonus, delirium, seizures
Propofol withdrawal not well-described but reported to resemble BZD withdrawal


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