Analgosedation during mechanical ventilation

In all critically ill patients, especially those on mechanical ventilation, it is first necessary to treat pain. Only after the establishment of adequate analgesia, the need for additional sedatives is estimated (take into account the synergistic effect of the analgesics and sedatives). Analgosedation level should be evaluated on a daily basis, several times per day, based on the pre-selected scale for the assessment of the level of sedation and pain. It is also necessary to provide adequate analgesia during procedural pain. For the treatment of non-neuropathic pain the first choice drugs are opioids. In patients receiving neuromuscular relaxants, it is necessary to monitor brain function. Discontinuation of sedation during the day, preferably in the morning hours, is recommended in order to monitor the neurological condition of the patient, prevent the occurrence of complications and allow gradual reduction in doseas well as the separation from the ventilator. For continuous sedation non-benzodiazepine sedatives(dexmedetomidin andpropofol) are recommended. It is recommended to routinely monitor delirium. Early mobilization of the patient in order to reduce the incidence and duration of delirium. Avoid benzodiazepines in the treatment of delirium, except in the cases of the benzodiazepine or alcohol withdrawal.