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Critical Care Sedation: The Concept

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Critical Care Sedation

Abstract

Since the need of sedation during the first experiences of invasive ventilation, the concept of sedation and pain control have been developed and, conceptually, separated. Nowadays, intensive care might need a different level of sedation (intensivists must make the patient in condition to tolerate the “trauma” of intensive care) and pain control (in case of traumatic injury, nursing, invasive maneuvers). Basically, intensivists should decide the level of sedation based on the level of invasive care, the prevision of ICU length of stay, the pain level, and the possibility of human contact maximization. Receptors involved in pharmacological control of consciousness are γ-aminobutyric acid (GABA) receptors, opioid receptors, glutamic acid receptors, and α2 adrenergic receptors. Sedation and pain control are therapies; thus, they must be decided with the same importance as well as antimicrobial or vasoactive support. The modern concept should be based on neurological monitoring, to improve relatives’ contact with the patients. Actually, international opinion remarks the reduction of sedative administration, so increasing the possibility of human contact. In this context, the eCASH concept (early Comfort using Analgesia, minimal Sedatives, and maximal Humane care) recently proposed could became a new point of view in sedation management.

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Authors and Affiliations

  1. Department of Anesthesia and Critical Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Giovanni Zagli & Lorenzo Viola

  2. Department of Health Sciences, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Giovanni Zagli & Lorenzo Viola

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  1. Giovanni Zagli
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  2. Lorenzo Viola
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Correspondence to Giovanni Zagli .

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Editors and Affiliations

  1. Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy

    Angelo Raffaele De Gaudio

  2. Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy

    Stefano Romagnoli

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Zagli, G., Viola, L. (2018). Critical Care Sedation: The Concept. In: De Gaudio, A., Romagnoli, S. (eds) Critical Care Sedation. Springer, Cham. https://doi.org/10.1007/978-3-319-59312-8_1

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  • DOI: https://doi.org/10.1007/978-3-319-59312-8_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59311-1

  • Online ISBN: 978-3-319-59312-8

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