The pharmacology of oversedation in mechanically ventilated adults

Abstract

To review pharmacological-related factors that affect the incidence of oversedation in mechanically ventilated adults. Recent epidemiologic studies have identified a high frequency of oversedation in the ICU that is attributable, in part, to a number of pharmacokinetic, pharmacogenetic, and pharmacodynamic factors. New evidence suggests that the administration of benzodiazepines, even when dosed intermittently, will lead to more oversedation than either propofol or dexmedetomidine and is associated with greater healthcare costs. Based on this data, clinicians should limit the use of benzodiazepines to those patients with anxiety, seizures, alcohol withdrawal, or in whom a deeper level of sedation or therapeutic paralysis is required. Recognition of these new advances will help liberate patients from mechanical ventilation sooner, without compromising patient comfort.