Should intensive care unit patients be deeply sedated?

Abstract

A 75-year-old man is admitted to the surgical intensive care unit (ICU) after an emergent laparotomy for perforated bowel. His medical history includes hypertension, diabetes, coronary artery disease, and previous alcohol abuse. On arrival to the ICU, he is acidotic and in septic shock, requiring norepinephrine and vasopressin infusions. Progressively over the next few hours in the ICU, vasopressor support has decreased and lactic acidosis is improving, but he now has acute respiratory distress syndrome (ARDS) and is being mechanically ventilated with lung protective ventilation. It is expected that his length of mechanical ventilation will exceed 48 h.