# On Safer Reinforcement Learning for Sedation and Analgesia in Intensive Care

arXiv: https://arxiv.org/abs/2601.23154 · HTML: https://mlsanity.com/paper/2601.23154/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 12 of its 49 references that are in the map.
- First posted on arXiv 30 Jan 2026.

## Builds on (most cited first, 12 of 12)

- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [Continuous control with deep reinforcement learning](https://mlsanity.com/paper/1509.02971/) (2015)
- [Addressing Function Approximation Error in Actor-Critic Methods](https://mlsanity.com/paper/1802.09477/) (2018)
- [Offline Reinforcement Learning: Tutorial, Review, and Perspectives on Open Problems](https://mlsanity.com/paper/2005.01643/) (2020)
- [Conservative Q-Learning for Offline Reinforcement Learning](https://mlsanity.com/paper/2006.04779/) (2020)
- [On the Properties of Neural Machine Translation: Encoder-Decoder Approaches](https://mlsanity.com/paper/1409.1259/) (2014)
- [Off-Policy Deep Reinforcement Learning without Exploration](https://mlsanity.com/paper/1812.02900/) (2018)
- [A Minimalist Approach to Offline Reinforcement Learning](https://mlsanity.com/paper/2106.06860/) (2021)
- [Stabilizing Off-Policy Q-Learning via Bootstrapping Error Reduction](https://mlsanity.com/paper/1906.00949/) (2019)
- [A Reinforcement Learning Approach to Weaning of Mechanical Ventilation in Intensive Care Units](https://mlsanity.com/paper/1704.06300/) (2017)
- [An Extensive Data Processing Pipeline for MIMIC-IV](https://mlsanity.com/paper/2204.13841/) (2022)
- [Deep Reinforcement Learning for Optimal Critical Care Pain Management with Morphine using Dueling Double-Deep Q Networks](https://mlsanity.com/paper/1904.11115/) (2019)

## Abstract (arXiv)

Pain management in intensive care usually involves complex trade-offs, since both inadequate and excessive treatment can compromise patient safety. Prior work on reinforcement learning for sedation and analgesia has explored how to optimize these interventions, but has not considered patient survival or partial observability. To investigate the risks of these design choices, we developed an offline deep reinforcement learning framework that suggests hourly medication doses based on recurrent state representations. Using retrospective data from 47,144 ICU stays in the MIMIC-IV database, we trained and evaluated behavior-regularized actor-critic models that prescribe continuous doses of opioids, propofol, benzodiazepines, and dexmedetomidine according to two goals: reduce pain or jointly reduce pain and 30-day post-discharge mortality. Although the two resulting policies were associated with lower pain, clinician agreement with the pain-only policy was positively correlated with mortality (ρ=0.119, p<0.0001), while agreement with the joint policy was negatively correlated (ρ=-0.316, p<0.0001). We found that such divergence arose from a different response to high levels of comorbidity. This suggests that valuing post-discharge outcomes could be critical for learning safer treatment policies, even if a short-term goal remains the primary objective.