Improving patient tolerance of mechanical ventilation. Challenges ahead.

The development of psychopharmacology and anesthesia practice in the ICU has lagged well behind the development of similar practices in other settings, notably the operating room. Because of important differences in the severity of organ dysfunction and the duration of treatment, however, lessons learned in other settings cannot be applied directly to the ICU. A fresh conceptual framework is needed to identify indications for sedating drugs and muscle relaxants in the ICU. New assessment tools are needed, both for clinical research and for clinical practice. More information is needed on the pharmacokinetics, adverse effects, and comparative costs of psychoactive drug use in the ICU. Practice guidelines are needed to improve efficacy and reduce errors associated with these drugs. The challenge is considerable. The reward is a more humane ICU experience for critically ill patients.