Sedation in the Surgical Intensive Care Unit

Authors

• Enoch Koo, University of LynchburgFollow

Specialty

Critical Care

Advisor

Dr. Debra Munsell

Abstract

In the surgical intensive care unit (SICU), sedation is an essential aspect of patient care in those who are agitated or mechanically ventilated. Proper sedation enables better recovery, shorter time to extubation, and more successful extubation. There are a variety of pharmacologic agents that can be used to continuously sedate a patient, such as dexmedetomidine or propofol, both of which are common agents used in traditional non-surgical ICUs. However, the SICU population presents unique challenges, as patients are often in more pain during their post-operative period, as well as having different hemodynamic targets and responses.

The goal of this paper is to determine the optimal sedation agent for mechanically ventilated patients in a SICU population. Current clinical review articles and studies were searched in PubMed, specifically focusing on those related to SICU or containing mechanically ventilated surgical patients. This focused approach was necessary because prior landmark trials, such as the Early Goal-Directed Sedation Compared With Standard Care in Mechanically Ventilated Critically Ill Patients Trial (SPICE III RCT),  Maximizing the Efficacy of Targeted Sedation and Reducing Neurological Dysfunction Trial (MENDS), and MENDS2 trials, were generalized to all ICU patients and often showed that in medical ICU patients, dexmedetomidine was associated with adverse effects without significant improvement in mortality. Newer studies specific to trauma surgical patients and multi-center SICU populations were included to provide more relevant context. This focused analysis indicated that while SICU-specific data are emerging, a universally optimal agent remains elusive. Despite this focused review, predicting which agent is best overall remains difficult due to the variety of surgeries, their implications, and the pre-existing comorbidities of patients in the SICU.

Keywords: surgical intensive care unit, dexmedetomidine, propofol, mechanical ventilation, mortality, extubation

Recommended Citation

Koo E. Sedation in the Surgical Intensive Care Unit. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).