The pharmacology of oversedation in mechanically ventilated adults

Purpose of review To review pharmacological-related factors that affect the incidence of overseclation in mechanically ventilated adults. Recent findings Recent epiderniologic studies have identified a high frequency of overseclation 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 overseclation 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. Summary Recognition of these new advances will help liberate patients from mechanical ventilation sooner, without compromising patient comfort.