Recent article from the Critical Care Medicine journal analyses the use of sedation among mechanically ventilated patients in the United States. I agree with the main point of this paper: more and more patients are being sedated using IV Propofol rather than IV benzodiazepines (BZ).

Just a few years ago, Propofol was considered to be a sedative of choice only for a short term sedation. A very short half life of this medication allows for rapid titration and awakening of the patient. It was ideal for the patients with a neurological impairment since you can assess their neurological status shortly after stopping the drug.

Now, and this study confirms it, Propofol is being used even for longer term sedation.
This is not surprising considering the advantages of this drug over other sedatives including benzodiazepines. Form a personal experience; it often takes a long time to reverse the sedative effect of IV BZ after several days of sedation. I believe it is easier to wean the patient off ventilator when IV Propofol is being used.

In less critically ill patients with a need for mechanical ventilation, I found that using intermittent doses of if BZ might provide adequate sedation without a need for a continuous infusion. Ideally, the patient should be arousable, yet comfortable on a ventilator.

A new drug, Precedex, is being introduced into the clinical practice. So far, I have a limited experience with this drug. The capability of this medicine to be continued after the patient is taken off the ventilator makes it a good choice for the patient who is ready to come off the ventilator. I have used Precedex on a several patients with a severe alcohol withdrawal syndrome when a more conventional treatment including IV BZ and Haldol failed to adequately sedate the patient. The use of this drug allowed me to avoid putting those patients on mechanical ventilation.