Usage of sedatives for delirious patients and its ethical problems in ICU

Abstract

Delirious patients in the ICU are sedated when they exhibit symptoms of agitation and excitement. Patients on mechanical ventilation receive sedatives such as midazolam and propofol as well as antipsychotics such as haloperidol, but dexmedetomidine is now used more frequently. Light and patient-optimized sedation is recommended, and many clinical studies have shown a reduced risk and duration of delirium with dexmedetomidine. Dexmedetomidine is preferred in the ICU due to favorable subjective sedation with nocturnal use; however, the notion that sedation with dexmedetomidine resembles natural sleep lacks rigid neurophysiological evidence. The Japanese Society for Palliative Medicine suggested that a careful consideration of the ethical aspects of continuous sedation in palliative care highlights the importance of sedation being appropriate, clear in purpose to the healthcare provider, consistent with patient and family wishes, and a team decision. This would apply to sedation of delirious patients. We encourage the daily monitoring of sedation and the suitable use of sedative drugs.