Target-controlled infusion for analgesia and sedation in the intensive care unit: a scoping review

Background: Target-controlled infusion (TCI) is widely used for total intravenous anesthesia; however, its role in the intensive care unit (ICU) for analgesia and sedation remains insufficiently defined. We performed a scoping review to describe the existing evidence on the applications of TCI in critically ill adults. Methods: In accordance with a registered protocol (Open Science Framework, April 3, 2025), we systematically searched major databases for randomized and non-randomized studies evaluating TCI in the ICU. Eight independent reviewers conducted study screening, data extraction, and risk of bias assessment. Results: Thirty-three articles comprising 1,273 patients met the inclusion criteria, 1,142 1 patients receiving TCI-based analgosedation and 106 receiving conventional strategies. Reported indications for TCI-based analgosedation included postoperative ventilation, postoperative pain control, and procedures associated with discomfort and pain. Only four studies directly compared TCI-based to conventional analgosedation strategies. Overall, TCI was feasible, safe, and allowed precise titration of analgesia and sedation. Most studies were judged to have a moderate risk of bias. Conclusions: Available data suggest that TCI-based analgosedation in the ICU is feasible and safe in the short term. Most available data are descriptive or exploratory and robust comparative clinical benefit has not yet been demonstrated. Further high-quality research is therefore needed to validate existing pharmacological models for prolonged infusions and to compare TCI with standard analgosedation practices regarding safety and patient-centered outcomes.