Agitation

Agitation in critically ill patients can be a consequence of many factors including pain, delirium, anxiety, drug withdrawal syndromes and discomfort due to poor ventilator synchrony, bowel dysfunction or pressure areas (Vincent et al., 2016). Management of agitation in the ICU should focus on diagnosing and rectifying the cause of the agitation, but will also typically involve keeping patients within a state of sedation (Barr et al., 2013; DAS Taskforce, 2015; Vincent et al., 2016). 

A number of predictive risk factors for agitation have been identified and should be considered when creating a patient’s individual treatment plan. Factors found to significantly predict a risk for developing agitation include (Jaber et al., 2005; Grounds et al., 2014):

Table 1. Risk factors for the development of agitation. Adapted from Grounds et al., 2014.

Predictive risk factors

Odds ratio

95% Cl

Alcohol abuse

2.61

1.03–6.58

Use of sedatives in 48 hours before onset of agitation

4.03

1.62–10.40

Body temperature > 38.0°C

4.52

1.80–11.49

Sodium level < 134mmol/L

4.87

1.58–14.99

Sodium level > 143mmol/L

4.95

1.95–12.54

Long-term psychoactive drug user

5.63

1.32–23.7

Abbreviations: CI, confidence interval.

 

Although certain patients may require deep sedation, guidelines in recent years have advocated a shift towards the use of light sedation where possible and a target of patients being calm, comfortable and cooperative (the 3Cs) (Barr et al., 2013; DAS Taskforce, 2015; Vincent et al., 2016). In fact, the guidelines recommend a target of light sedation that is broadly equivalent to a RASS score of 0/-1 (DAS Taskforce, 2015; Vincent et al., 2016). Despite these guideline recommendations, it is apparent that deep sedation is still widely used (TEAM Study, 2015).

How to Assess

How to Assess

Consider the various tools available for the assessment and monitoring of agitation.

Guidelines

Guidelines

Explore the tools available to reduce agitation in the most effective and appropriate manner.

Treatment Options

Treatment Options

Learn about the different effects and side effects which result from the use of sedatives for the treatment of agitation.

Agitation References

Agitation References

View all the works cited within the Agitation section of the PAD Management Knowledge Centre.