In this third part of our sedation series, we explore one of the biggest game-changers in ICU practice: sedation depth.
For years, the approach was "sedate and stabilise" — often to deep levels. But mounting evidence tells a different story: early deep sedation, especially in the first 48 hours, worsens outcomes.
📉 The risks of deep sedation
Higher hospital and 180-day mortality (SPICE study, Shehabi et al., 2013)
Longer time to extubation and ICU stay
Increased long-term disability
🧠 Sedation and delirium
Strong links between deep sedation and ICU delirium (Ely et al., 2005; Tanaka et al., 2014)
Delirium predicts worse survival and cognitive outcomes
🏥 Impact on ventilation and recovery
More time ventilated
Higher risk of infections
Longer ICU and hospital stays
🛠️ Strategies for safer practice
Set clear sedation targets (RASS –1 to 0)
Protocolised, nurse-driven sedation adjustment
Start light and reassess frequently
Deep sedation only when clearly indicated (e.g., severe ARDS, TBI, refractory agitation)
Takeaway:
Early deep sedation is a modifiable risk factor. The mantra is simple: "light unless otherwise indicated." Less really is more — and safer.
