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Resource type: Article

Sedation (drugs to keep patients comfortable)

What is sedation?

Sedatives are the drugs we give patients to keep them sleepy and comfortable whilst in Intensive Care.They are usually given into a line or drip, directly into the patient's bloodstream.

Why are sedatives used in Intensive Care?

When a patient is very ill, the body may struggle to cope with the severity of their illness or with some of the things we have to do in order to treat their illness. Being connected to a ventilator or breathing machine via a breathing tube (also known as an endotracheal or ET tube) can be very uncomfortable, for example, as can having various tubes or lines inserted, or recovering after an operation.

Making sure that we give just the right type and amount of sedative drugs is a very important part of what we do in Intensive Care.If we give too much,patients may spend longer on the ventilator or breathing machine. If we give too little, patients can become uncomfortable or distressed.

Why are some patients more asleep than others?

Patients are usually more heavily sedated or sleepy during the first few days of their stay in Intensive Care and may, in fact, be unconscious. This is so that we can keep them comfortable while we stabilise their condition. (Being unconscious may also, however, be due to the severity or type of illness.) Some patients remain asleep, even when they haven't received sedative drugs for several days. This can happen for several reasons, including how quickly the body is able to clear these drugs from the system.

Can patients hear us when they are very asleep?

It is possible that patients can hear and feel what is going on around them, even when apparently unconscious, but they might be too sleepy to respond when we speak to them or hold their hand. This is the reason that the nurses explain everything they are doing to the patient and why.

How are patients woken up?

Importantly, research tells us that the less sedative drugs we use in Intensive Care, the better. Having patients slightly more "awake" means that it is easier to reduce the amount of support they need from the ventilator or breathing machine, that we can remove the breathing tube more quickly and that they spend less time in Intensive Care. They may also be at less risk of developing a chest infection or pneumonia.

It can sometimes be difficult, however,to balance the need for comfort and safety with the need to reduce the amount of sedation patients receive.In order to safely maintain this balance, the nursing staff regularly assess how awake the patient is by carrying out various tests. They usually start to reduce the amount of sedation once the patient's condition has stabilised.

Why do some patients get anxious and confused when their sedation is reduced?

Patients can respond differently when they start to become more aware of their surroundings. Some patients stay calm while others may become confused, anxious and agitated. Many experience strange dreams, paranoia or hallucinations (known as "delirium") and may become fidgety or aggressive or just not like themselves. While it can be very upsetting for family members to see this, delirium  is a temporary condition and will get better as the patient recovers.The nurses regularly assess patients for delirium and may treat this condition with other short acting drugs.