Management of Agitation in ICU Patients

Assessment and Identification of Causes

Agitation in ICU patients should be routinely assessed using validated scales such as the Richmond Agitation-Sedation Scale (RASS) or Sedation-Agitation Scale (SAS) 3
Identify and address underlying causes of agitation, including pain, delirium, hypoxemia, withdrawal syndromes, and medication side effects 3, 4, 5, 1

Dexmedetomidine is suggested as the preferred sedative agent over benzodiazepines to reduce the duration of delirium in delirious ICU patients 2, 6, 1
Intravenous opioids are recommended as first-line analgesic therapy for pain-related agitation, with consideration of adding non-opioid analgesics to reduce opioid side effects 3
Atypical antipsychotics may reduce the duration of delirium in adult ICU patients, but are not recommended for routine use to treat delirium (evidence level C) 4, 7, 1

Early mobilization is strongly recommended to reduce the incidence and duration of delirium and associated agitation 2
Optimize the patient's environment to promote sleep by controlling light and noise, clustering patient care activities, and decreasing stimuli at night 7, 3, 2

For mechanically ventilated patients, maintain lighter levels of sedation when possible, consider daily sedation interruption, and use analgesia-first sedation approach 3, 2
For patients receiving neuromuscular blocking agents, use brain function monitors as adjuncts to monitor depth of sedation 3

Rivastigmine is not recommended for reducing the duration of delirium in ICU patients (evidence level -1B) 4, 7
Prophylactic use of haloperidol or atypical antipsychotics is not recommended to prevent delirium 2

Monitor for adverse effects including oversedation, QT prolongation, and respiratory depression 1