Cost considerations in sedation, analgesia, and neuromuscular blockade in the intensive care unit

Sedation of critically ill patients is a costly endeavor. Costs of commonly used intensive care unit (ICU) sedatives range from pennies to more than $ 500 per day. Although the agents account for some of this expense, complica tions related to the use of these drugs in the ICU produce even greater cos ts. Prolongation of mechanical ventilation and length of stay are some of t he common complications resulting from non-ideal use of these drugs. Sedati ve agents also impair neurological evaluation in many critically ill patien ts, which may mask detection of acute delirium resulting from intercurrent illness or intracranial catastrophes and can lead to excessive diagnostic t esting. Opiates may result in gastrointestinal dysfunction with resulting m alnutrition and perhaps bacterial translocation and sepsis, Neuromuscular b locking agents may cause prolonged paralysis and disability in critically i ll patients who receive them. Simple dosing strategies based on pharmacolog ical principles may decrease the incidence of these costly problems.