Sedation in ACHD

Abstract

Over the last decade, focus on appropriate sedation management in the intensive care unit (ICU) is rising. ICU delirium, psychological trauma, and prolonged immobilization have been recognized as major factors impacting the outcome of critically ill patients. Current guidelines incorporate the management of pain, agitation, and delirium with a focus on decreasing sedation-induced adverse events. More specific analgesic and sedation strategies, daily spontaneous awakening and breathing trials, early extubation and mobilization, and measures to decrease ICU delirium are being implemented resulting in improved outcomes. With the constant rise of congenital heart disease (CHD) patients reaching adult age, ICUs and their intensivists are confronted with particular challenges when these patients become critically ill. Unique physiologic and psychosocial aspects often require adjustment in the medical management, including sedation regimens. With an understanding of the interaction between sedatives and the adult congenital heart disease (ACHD) pathophysiology, modern ICU sedation management can be applied to optimize outcomes in this specific patient population. In this chapter, we will discuss current ICU sedatives, specific ACHD pathophysiology, and how these two interact. We will describe modern aspects of critical care sedation and their application to critically ill patients with CHD.