Sedation and Analgesia in ICU

A 58-year-old male admitted to the ICU following an open cholecystectomy is on mechanical ventilation. He is receiving fentanyl infusion (2 µg/kg/hr) for analgesia and midazolam (0.05 mg/kg/hr) for sedation. On day 3, the team notes he is deeply sedated (RASS −4), with minimal spontaneous breathing effort, and has developed acute kidney injury (creatinine 2.8 mg/dL, up from 1.0 preoperatively). Urine output is 0.3 mL/kg/hr. The attending suspects accumulation of active metabolites. Which of the following sedative agents would be most appropriate to switch to in this clinical scenario?

A 72-year-old woman with COPD (FEV₁ 35% predicted) is intubated in the ICU for acute exacerbation with respiratory failure. She is on low-dose morphine (2 mg IV boluses every 4 hours) for pain and anxiety, and the team is considering adding a sedative agent. Her blood pressure is 145/88 mmHg, heart rate 92 bpm, and she has a history of hypertension and coronary artery disease. Which of the following sedative agents should be avoided in this patient, and why?

Which of the following sedative agents is associated with the highest risk of propofol infusion syndrome (PRIS) when used for prolonged sedation in the ICU?

According to the Richmond Agitation-Sedation Scale (RASS), which score indicates moderate sedation where the patient is difficult to arouse but awakens to verbal stimuli?