Critical Care Medicine-Neurologic Disorders>>>>>Analgesia, Sedation and Neuromuscular Blockade
Question 5#

Which of the following medications is recommended to use as a sleep aid for ICU patients?

A. Melatonin
B. Dexmedetomidine
C. Propofol
D. Midazolam
E. None of the above

Correct Answer is E

Comment:

Correct Answer: E

The 2018 Society for Critical Care Medicine Clinical Practice guidelines for pain and agitation/sedation, delirium, and sleep do not suggest using any medications for sleep. The guidelines state there is currently insufficient evidence to recommend any medications to promote sleep in critically ill patients. There is low-quality evidence to suggest melatonin is helpful for improving sleep in critically ill patients. Although melatonin has a low side effect profile, there is no recommendation for or against its use as the current evidence is of very low quality. The guidelines do not suggest using propofol solely to improve sleep. Dexmedetomidine increases stage 2 sleep in critically ill patients but has not demonstrated reduction in sleep fragmentation, or an increase in deep or REM sleep. So, the guidelines do not recommend dexmedetomidine to promote sleep.

Reference:

1. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):e825-e873