Episode 3 – Sedation Depth: How Deep Is Too Deep?

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.