Sedative choice and ventilator-associated patient outcomes: don’t sleep on delirium

Sedation is an integral component of care for critically ill and intubated patients. The adult intensive care unit (ICU) literature suggests that the choice of sedative agent may be central to patient outcomes during and after mechanical ventilation (1). Current guidelines recommend avoidance of benzodiazepines in preference of propofol or dexmedetomidine, and highlight a preference for maintaining light levels of sedation in critically ill adult patients. These guidelines stem largely from research comparing benzodiazepine to non-benzodiazepine sedatives (2), and more specifically, dexmedetomidine to midazolam, with or without propofol (3,4). Patients who received dexmedetomidine spent less time on the ventilator and experienced less delirium. However, comparisons between dexmedetomidine and propofol are limited.