Sedation, Analgesia, and Paralysis

Abstract Summary Providing sedation and analgesia is an integral part of caring for critically ill patients. Clinical practice guidelines provide a general framework for the provision of comfort and prevention of distress through effective analgesia and minimal sedation. The need for patient-centred, symptom-oriented approach is essential to cater for the needs of individual patients. Clinicians caring for coronavirus SARS-CoV2-induced respiratory failure on mechanical ventilation faced many challenges in this context, balancing different therapeutic interventions, such as prone ventilation, with analgesia, sedation, and paralytics needs of each patient. While no one agent can provide the needs of all patients, many patients, acuity, complexity, and presenting illness factors are important determinants of individual patient’s need. These factors dictate what agent/s to be used, as monotherapy or in combination, what sedation intensity is required, what monitoring to be used, and how to reduce the risk of emergent delirium and sedative/analgesic withdrawal. In this chapter, we offer a tailored algorithm to facilitate the provision of low-, medium-, and high-intensity sedation strategies and an algorithm for managing agitated delirium in critically ill patients.