Just as the concept of the “triad of anesthesia” underscores the pharmacodynamic
interactions among hypnotics, analgesics, and muscle relaxants and the
recognition that the simultaneous administration of agents of each class permits
the use of lower doses of drugs of all classes, the concept of the “ICU triad” recognizes
that pain, agitation, and delirium — and therefore approaches to their
management — are inextricably linked (Fig. 1). According to the principle that it
is better to treat disease than to mask it, sedatives should be used only when pain
and delirium have been addressed with the use of specific pharmacologic and
nonpharmacologic strategies