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To the Editor: Dr Ostermann and colleagues¹ reviewed 49 randomized controlled trials of sedation agents administered to patients in intensive care units. Only 32 of these 49 trials met the basic criteria for inclusion in their review. Thirty of these selected trials used a sedation scale to target the sedation delivery, and only 50% of the trials had patients at the prescribed sedation level for more than 50% of the time. Most critical care units still do not use protocols that include a sedation scoring system,² and it would seem that from this article even the units that do use them do not aggressively use a reassessment protocol and adjust the sedation to the level prescribed.

There are many complications associated with undersedation (patient injury, posttraumatic stress disorder) and oversedation (respiratory depression, prolonged time requiring mechanical ventilation, increased cost, unrecognized cerebral insult) that could be prevented by the proper use . . . [Full Text of this Article]

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