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The use of ICU pain assessment tools and daily sedation interruption have led to reduction in ICU length of stay (LOS) and patient mortality rates. The appropriate management of analgesia and sedation (see Chapter 2) can translate into significant improvements in outcome, a shortened duration of mechanical ventilation, a reduced incidence of delirium, and a reduced incidence of significant long‐term physical and cognitive dysfunction in ICU survivors.

 Pain, anxiety, agitation, and PTSD have been widely studied in ventilated patients in the ICU. No one sedative agent has been reported to improve the risk of mortality among the critically ill or injured when compared in randomized control trials. For example, propofol may be associated with a shorter time to extubation and recovery from sedation when compared with midazolam. However, the risk of hypertriglyceridemia and hypotension is higher with propofol.

 Propofol has also been associated with propofol‐related infusion syndrome (PRIS) which includes worsening metabolic acidosis, rhabdomyolysis, hypertriglyceridemia, hypotension, and arrhythmias. Some risk factors for PRIS are:High propofol doses.Prolonged infusion.Liver disease.Use of vasopressors.Underlying mitochondrial disease.

 Dexmedetomidine has been linked to a lower risk of drug‐associated delirium than alternative sedative agents, but it increases risk of bradycardia and hypotension.

 Only a minority of critically ill patients require deep sedation, for conditions such as severe respiratory failure (e.g. ARDS), intracranial hypertension, and refractory status epilepticus.

  Daily sedation interruption and use of sedation scales to target light sedation have been shown to reduce ventilator time and ultimately LOS. The Richmond Agitation‐Sedation Scale (RASS) and Riker Sedation‐Agitation Scale (see Chapter 2) have the best reliability and are recommended by clinical practice guidelines.

 Critical illness polyneuropathy (CIP) and myopathy (CIM) are major complications of severe critical illness and its management. CIP/CIM affects both motor and sensory axons and, as a consequence, can prolong weaning from mechanical ventilation and physical recovery. Sepsis, systemic inflammatory response syndrome, and multiple organ failure play a crucial role in CIP/CIM. Prevention of risk factors such as high dose steroids, prolonged neuromuscular blockade, prolonged immobility, treatment of the underlying critical illness, and supportive care are the mainstay of treatment. Early mobilization and physical therapy in the ICU have been shown to prevent, as well as aid in treatment of, CIP. Early rehabilitation in the ICU is safe and associated with several benefits, including improvements in muscle strength, functional mobility, quality of life, and reduction in ICU delirium.