Early goal-directed sedation in mechanically ventilated patients

The use of sedative drugs in intensive care is ubiquitous. Every year, more than 3 million patients worldwide, 50,000 patients in Australia and New Zealand [1, 2] and nearly 800,000 in the United States receive mechanical ventilation and sedation with an in-hospital mortality (2005) of 34.5 . The estimated US national cost per annum reached nearly US27 billion in 2005 [3]. In Ontario, in 1992, the number of mechanically ventilated patients was 221/100,000 population with the estimated number of ventilated patients across Canada likely to exceed 75,000 per annum [4]. The number of ventilated patients per 100,000 population is likely to be similar in Europe. Projections suggests that this number is expected to rise by 31 over the next decade [5]. Almost all ventilated patients receive sedative agents in one form or another [6]. Sedation is given to promote tolerance of endotracheal intubation and associated life-sustaining interventions, including mechanical ventilation, and to relieve anxiety and reduce distress [6]. Thus, sedation is considered vital to patient comfort and safety.