Summary: University of Virginia Health System
Clinical Practice Guideline
Adult Critical Care Sedation Guideline
© 2005 by the Rector and Board of Visitors of the University of Virginia
Created by Adult Critical Care Sedation Workgroup: 12/20/04; Revised: 8/22/05; Approved by CSEC Patient Care Committee: 8/2005
Updated: 1/8/07 CF
1. If a reason for pain exists, treat pain first.
2. Once pain has been addressed, then establish a reason for the use of sedatives. Reasons may include:
amnesia, patient safety/ agitation management, substance withdrawal, sleep, anxiolysis, ventilator
synchrony, or control of ICP. Remember that the combination of analgesics and sedatives are synergistic.
3. If delirium (confused and/or disordered thinking) is suspected, consider the use of antipsychotics.
4. Consider non-pharmacologic interventions to reduce symptoms of discomfort/distress.
5. Choose a sedation target in collaboration with the health care team using the Richmond Agitation-Sedation
6. PRN/bolus dosing by IV or enteral route is the preferred method for managing sedation. Sedative infusions
may be used for patients meeting exclusion criteria for daily wean (see 1. below), or when PRN/bolus
dosing is ineffective.
7. Chemically paralyzed patients should have the paralytic turned off before weaning any sedative or