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Patient comfort should be a primary goal in the intensive care unit (ICU), including adequate pain control, anxiolysis, and prevention and treatment of delirium.

However, achieving the appropriate balance of sedation and analgesia is challenging.

The RASS has been demonstrated to have excellent interrater reliability in a broad range of adult medical and surgical ICU patients and to have excellent validity when compared to a visual analogue scale and other sedation scales.

This RASS takes less than 20 seconds to perform with minimal training, and has been shown to be highly reliable among multiple types of healthcare providers.

These are all discussed to some degree in the references for the sedation clinical practice guidelines and the RASS.

Of the available scales the PADIS guidelines recommend the use of the RASS and the SAS based on published literature and the psychometric properties of the scale.

An analgesia based approach may be adequate for a majority of critically ill patients without the need for additional sedative medications.

Level of agitation and sedation should be monitored frequently with agitation-sedation scales such as the RASS or SAS.

Many patients require sedation during diagnostic or therapeutic procedures.

When additional sedation is required due to agitation or anxiety, then sedation strategies using non-benzodiazepine sedatives (either propofol or dexmedetomidine) may be preferred over sedation with benzodiazepines (either midazolam or lorazepam) to improve clinical outcomes, in mechanically ventilated adult ICU patients.

Light levels of sedation should be maintained either via goal-directed therapy, or via incorporation of daily awakening trials coordinated with daily wake up trials More information can be found on the Both SAT and SBT page.

These techniques should be used only by health care professionals skilled in managing complications, including cardiorespiratory compromise.

It is important to take a complete history and perform a thorough physical examination, paying special attention to the selection of pharmacologic agents.

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Much of our group's recent and ongoing research centers around improving these issues in critical care practice.

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