{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:22:37Z","timestamp":1789024957797,"version":"build-2803163510"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T00:00:00Z","timestamp":1656028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007343","name":"Universit\u00e0 degli Studi di Brescia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007343","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>The clinical approach to sedation in critically ill patients has changed dramatically over the last two decades, moving to a regimen of light or non-sedation associated with adequate analgesia to guarantee the patient\u2019s comfort, active interaction with the environment and family, and early mobilization and assessment of delirium. Although deep sedation (DS) may still be necessary for certain clinical scenarios, it should be limited to strict indications, such as mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS), status epilepticus, intracranial hypertension, or those requiring target temperature management. DS, if not indicated, is associated with prolonged duration of mechanical ventilation and ICU stay, and increased mortality. Therefore, continuous monitoring of the level of sedation, especially when associated with the raw EEG data, is important to avoid unnecessary oversedation and to convert a DS strategy to light sedation as soon as possible. The approach to the management of critically ill patients is multidimensional, so targeted sedation should be considered in the context of the ABCDEF bundle, a holistic patient approach. Sedation may interfere with early mobilization and family engagement and may have an impact on delirium assessment and risk. If adequately applied, the ABCDEF bundle allows for a patient-centered, multidimensional, and multi-professional ICU care model to be achieved, with a positive impact on appropriate sedation and patient comfort, along with other important determinants of long-term patient outcomes.<\/jats:p>","DOI":"10.3389\/fmed.2022.901343","type":"journal-article","created":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T13:30:05Z","timestamp":1656077405000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":27,"title":["Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients"],"prefix":"10.3389","volume":"9","author":[{"given":"Nicola","family":"Gitti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Renzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Marchesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Bertoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco A.","family":"Lobo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank A.","family":"Rasulo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Goffi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Pozzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Piva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,6,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2021.102356","article-title":"Adult sedation and analgesia in a resource limited intensive care unit \u2013 a systematic review and evidence based guideline.","volume":"66","author":"Temesgen","year":"2021","journal-title":"Ann Med Surg (Lond)."},{"key":"B2","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1097\/CCM.0000000000003482","article-title":"Caring for critically ill patients with the ABCDEF bundle: results of the ICU liberation collaborative in over 15,000 adults.","volume":"47","author":"Pun","year":"2019","journal-title":"Crit Care Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"126","DOI":"10.5005\/jp-journals-10071-23712","article-title":"Consensus statement on analgo-sedation in neurocritical care and review of literature.","volume":"25","author":"Prabhakar","year":"2021","journal-title":"Indian J Crit Care Med."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009771.pub2","article-title":"Protocol-directed sedation versus non-protocol-directed sedation to reduce duration of mechanical ventilation in mechanically ventilated intensive care patients.","author":"Aitken","year":"2015","journal-title":"Cochrane Database of Systematic Reviews."},{"key":"B5","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/S2213-2600(16)30178-3","article-title":"Staff education, regular sedation and analgesia quality feedback, and a sedation monitoring technology for improving sedation and analgesia quality for critically ill, mechanically ventilated patients: a cluster randomised trial.","volume":"4","author":"Walsh","year":"2016","journal-title":"Lancet Respir Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1164\/ajrccm.153.3.8630539","article-title":"Sedation of critically ill patients during mechanical ventilation. A comparison of propofol and midazolam.","volume":"153","author":"Kress","year":"1996","journal-title":"Am J Respir Crit Care Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/S0140-6736(08)60105-1","article-title":"Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomised controlled trial.","volume":"371","author":"Girard","year":"2008","journal-title":"Lancet."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.1001\/jama.2012.13872","article-title":"Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial.","volume":"308","author":"Mehta","year":"2012","journal-title":"JAMA."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1186\/2110-5820-4-14","article-title":"Daily sedative interruption versus intermittent sedation in mechanically ventilated critically ill patients: a randomized trial.","volume":"4","author":"Nassar","year":"2014","journal-title":"Ann Intensive Care."},{"key":"B10","doi-asserted-by":"publisher","first-page":"2180","DOI":"10.1097\/CCM.0000000000001196","article-title":"Recall of ICU stay in patients managed with a sedation protocol or a sedation protocol with daily interruption.","volume":"43","author":"Burry","year":"2015","journal-title":"Crit Care Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1164\/rccm.200303-455OC","article-title":"The long-term psychological effects of daily sedative interruption on critically ill patients.","volume":"168","author":"Kress","year":"2003","journal-title":"Am J Respir Crit Care Med."},{"key":"B12","doi-asserted-by":"crossref","DOI":"10.1097\/CCM.0000000000003259","article-title":"Clinical practice guidelines for the prevention and management of pain, agitation\/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU.","volume":"46","author":"Devlin","year":"2018","journal-title":"Crit Care Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1007\/s00134-013-2830-2","article-title":"Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study.","volume":"39","author":"Shehabi","year":"2013","journal-title":"Intensive Care Med."},{"key":"B14","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1164\/rccm.201203-0522OC","article-title":"Early intensive care sedation predicts long-term mortality in ventilated critically ill patients.","volume":"186","author":"Shehabi","year":"2012","journal-title":"Am J Respir Crit Care Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1983","DOI":"10.1097\/CCM.0b013e31828a437d","article-title":"Early goal-directed sedation versus standard sedation in mechanically ventilated critically ill patients: a pilot study*.","volume":"41","author":"Shehabi","year":"2013","journal-title":"Crit Care Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1097\/CCM.0000000000002885","article-title":"Practice patterns and outcomes associated with early sedation depth in mechanically ventilated patients: a systematic review and meta-analysis.","volume":"46","author":"Stephens","year":"2018","journal-title":"Crit Care Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1136\/thoraxjnl-2020-216098","article-title":"Inconsistent relationship between depth of sedation and intensive care outcome: systematic review and meta-analysis.","volume":"76","author":"Aitken","year":"2021","journal-title":"Thorax."},{"key":"B18","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1056\/NEJMoa1906759","article-title":"Nonsedation or light sedation in critically ill, mechanically ventilated patients.","volume":"382","author":"Olsen","year":"2020","journal-title":"N Engl J Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1007\/s00134-016-4297-4","article-title":"Comfort and patient-centred care without excessive sedation: the eCASH concept.","volume":"42","author":"Vincent","year":"2016","journal-title":"Intensive Care Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1097\/00003246-199907000-00022","article-title":"Prospective evaluation of the sedation-agitation scale for adult critically ill patients.","volume":"27","author":"Riker","year":"1999","journal-title":"Crit Care Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1164\/rccm.2107138","article-title":"The Richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients.","volume":"166","author":"Sessler","year":"2002","journal-title":"Am J Respir Crit Care Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1097\/CCM.0000000000003071","article-title":"Sedation intensity in the first 48 hours of mechanical ventilation and 180-day mortality: a multinational prospective longitudinal cohort study.","volume":"46","author":"Shehabi","year":"2018","journal-title":"Crit Care Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2342","DOI":"10.1007\/s00134-020-06307-9","article-title":"Analgesia and sedation in patients with ARDS.","volume":"46","author":"Chanques","year":"2020","journal-title":"Intensive Care Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1056\/NEJMoa1005372","article-title":"Neuromuscular blockers in early acute respiratory distress syndrome.","volume":"363","author":"Papazian","year":"2010","journal-title":"N Engl J Med."},{"key":"B25","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1056\/NEJMoa1901686","article-title":"Early neuromuscular blockade in the acute respiratory distress syndrome.","volume":"380","author":"Moss","year":"2019","journal-title":"N Engl J Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1977","DOI":"10.1007\/s00134-020-06227-8","article-title":"Neuromuscular blockade in patients with ARDS: a rapid practice guideline.","volume":"46","author":"Alhazzani","year":"2020","journal-title":"Intensive Care Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1001\/jama.2009.56","article-title":"Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial.","volume":"301","author":"Riker","year":"2009","journal-title":"JAMA."},{"key":"B28","doi-asserted-by":"publisher","first-page":"2644","DOI":"10.1001\/jama.298.22.2644","article-title":"Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial.","volume":"298","author":"Pandharipande","year":"2007","journal-title":"JAMA."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1001\/jama.2012.304","article-title":"Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials.","volume":"307","author":"Jakob","year":"2012","journal-title":"JAMA."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1969","DOI":"10.1007\/s00134-008-1186-5","article-title":"The use of propofol for medium and long-term sedation in critically ill adult patients: a meta-analysis.","volume":"34","author":"Ho","year":"2008","journal-title":"Intensive Care Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/s00408-015-9820-9","article-title":"Impact of sedation on cognitive function in mechanically ventilated patients.","volume":"194","author":"Porhomayon","year":"2016","journal-title":"Lung."},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182a16898","article-title":"Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill adults: a systematic review and meta-analysis of randomized trials.","volume":"41","author":"Fraser","year":"2013","journal-title":"Crit Care Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e434","DOI":"10.1097\/CCM.0000000000005425","article-title":"Differential effects of gamma-aminobutyric acidergic sedatives on risk of post-extubation delirium in the ICU: a retrospective cohort study from a New England health care network.","volume":"50","author":"Azimaraghi","year":"2022","journal-title":"Crit Care Med."},{"key":"B34","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/j.bja.2017.11.100","article-title":"Pharmacokinetic and pharmacodynamic study of intranasal and intravenous dexmedetomidine.","volume":"120","author":"Li","year":"2018","journal-title":"Br J Anaesth."},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-015-0043-2","article-title":"Sleeping on a problem: the impact of sleep disturbance on intensive care patients \u2013 a clinical review.","volume":"5","author":"Delaney","year":"2015","journal-title":"Ann Intensive Care."},{"key":"B36","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1007\/s00134-021-06356-8","article-title":"Early sedation with dexmedetomidine in ventilated critically ill patients and heterogeneity of treatment effect in the SPICE III randomised controlled trial.","volume":"47","author":"Shehabi","year":"2021","journal-title":"Intensive Care Med."},{"key":"B37","doi-asserted-by":"crossref","first-page":"75","DOI":"10.34161\/johta.2016.4.2.006","article-title":"A cost-minimization analysis comparing dexmedetomidine with midazolam and propofol for sedation in mechanically ventilated intensive care unit patients.","volume":"4","author":"Park","year":"2016","journal-title":"Int J Technol Assess Health Care."},{"key":"B38","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1097\/CCM.0b013e3181bc81c9","article-title":"A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit.","volume":"38","author":"Dasta","year":"2010","journal-title":"Crit Care Med."},{"key":"B39","doi-asserted-by":"crossref","first-page":"389","DOI":"10.2147\/CEOR.S242994","article-title":"Cost-minimization analysis of dexmedetomidine compared to other sedatives for short-term sedation during mechanical ventilation in the United States.","volume":"12","author":"Aggarwal","year":"2020","journal-title":"Clinicoecon Outcomes Res."},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1186\/cc8916","article-title":"Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial.","volume":"14","author":"Pandharipande","year":"2010","journal-title":"Crit Care."},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-020-03115-x","article-title":"The effect of dexmedetomidine on vasopressor requirements in patients with septic shock: a subgroup analysis of the Sedation Practice in Intensive Care Evaluation [SPICE III] trial.","volume":"24","author":"Cioccari","year":"2020","journal-title":"Crit Care."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1056\/NEJMoa2024922","article-title":"Dexmedetomidine or propofol for sedation in mechanically ventilated adults with sepsis.","volume":"384","author":"Hughes","year":"2021","journal-title":"N Engl J Med."},{"key":"B43","first-page":"329","article-title":"Bispectral Index compared to Ramsay score for sedation monitoring in intensive care units.","volume":"72","author":"Consales","year":"2006","journal-title":"Minerva Anestesiol."},{"key":"B44","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s10877-007-9087-7","article-title":"Comparing entropy and the bispectral index with the Ramsay score in sedated ICU patients.","volume":"21","author":"Hern\u00e1ndez-Gancedo","year":"2007","journal-title":"J Clin Monit Comput."},{"key":"B45","doi-asserted-by":"crossref","DOI":"10.1186\/cc910","article-title":"Bispectral index (BIS) monitoring of ICU patients on continuous infusion of sedatives and paralytics reduces sedative drug utilization and cost.","volume":"4","author":"Kaplan","year":"2000","journal-title":"Crit Care."},{"key":"B46","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.bpa.2020.10.007","article-title":"Does electroencephalographic burst suppression still play a role in the perioperative setting?","volume":"35","author":"Lobo","year":"2021","journal-title":"Best Pract Res Clin Anaesthesiol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1055\/s-0040-1719073","article-title":"Electroencephalogram monitoring in critical care.","volume":"40","author":"Rubinos","year":"2020","journal-title":"Semin Neurol."},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011240.pub2","article-title":"BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization.","volume":"2","author":"Shetty","year":"2018","journal-title":"Cochrane Database Syst Rev."},{"key":"B49","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1097\/ACO.0b013e32834c7aba","article-title":"Limitations of anaesthesia depth monitoring.","volume":"24","author":"Lobo","year":"2011","journal-title":"Curr Opin Anaesthesiol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1213\/01.ane.0000167269.62966.af","article-title":"Different conditions that could result in the bispectral index indicating an incorrect hypnotic state.","volume":"101","author":"Dahaba","year":"2005","journal-title":"Anesth Analg."},{"key":"B51","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1097\/ACO.0b013e3283304032","article-title":"Processed electroencephalogram in depth of anesthesia monitoring.","volume":"22","author":"Palanca","year":"2009","journal-title":"Curr Opin Anaesthesiol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1016\/j.ncl.2021.04.006","article-title":"Neurocritical care and brain monitoring.","volume":"39","author":"Riviello","year":"2021","journal-title":"Neurol Clin."},{"key":"B53","doi-asserted-by":"publisher","first-page":"1214","DOI":"10.1007\/s12630-021-01962-y","article-title":"Educational initiatives for electroencephalography in the critical care setting: a systematic review and meta-analysis.","volume":"68","author":"Taran","year":"2021","journal-title":"Can J Anaesth."},{"key":"B54","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1177\/0310057X1103900310","article-title":"Meta-analysis of randomised controlled trials on daily sedation interruption for critically ill adult patients.","volume":"39","author":"Augustes","year":"2011","journal-title":"Anaesth Intensive Care."},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1111\/ijn.12948","article-title":"Effects of daily sedation interruption in intensive care unit patients undergoing mechanical ventilation: a meta-analysis of randomized controlled trials.","volume":"28","author":"Chen","year":"2021","journal-title":"Int J Nurs Pract."},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009176.pub2","article-title":"Daily sedation interruption versus no daily sedation interruption for critically ill adult patients requiring invasive mechanical ventilation.","volume":"2018","author":"Burry","year":"2014","journal-title":"Cochr Database Syst Rev."},{"key":"B57","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1016\/j.ijnss.2014.10.011","article-title":"Effectiveness of daily interruption of sedation in sedated patients with mechanical ventilation in ICU: a systematic review.","volume":"1","author":"Chen","year":"2014","journal-title":"Int J Nurs Sci."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.901343\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T13:30:15Z","timestamp":1656077415000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2022.901343\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,24]]},"references-count":57,"alternative-id":["10.3389\/fmed.2022.901343"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2022.901343","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,24]]},"article-number":"901343"}}