The best sedation drug—a quest for the holy grail?

Over the last 15 years, knowledge on sedation has increased substantially and as a result, the paradigm of sedation practices has moved entirely from a deep sedated, unconscious patient to an awake, collaborative and moving ventilated patient. Over-sedation is increasingly recognized as a cause morbidity resulting in an extended length of stay and longer duration of mechanical ventilation. Early deep sedation has also been associated with higher in-hospital mortality in an observational study performed in 45 Brazilian ICUs (1). Reflecting the current evidence, the most recent guidelines of the Society of Critical Care Medicine recommend titration of sedatives to achieve light sedation unless clinically contraindicated (2).