Critically evaluate the role of a daily interruption of sedation for mechanically ventilated patients in the ICU.
Introduction / Rationale
A daily interruption of sedation is a strategy designed to reduce exposure to sedative agents, allow assessment of neurological status and assess readiness for extubation and to reduce duration of mechanical ventilation.
Initial trials showed a marked reduction in duration of mechanical ventilation, and decreased duration of intensive care length of stay (e.g. Kress et al, NEJM 2000). It was notable that no sedation target nor protocol was used in the control group, thus this group may have been oversedated, analogous to the 12ml/kg TV group in the ARDSNET low TV trial.
Subsequent studies have been somewhat conflicting:
Disadvantages / Adverse effects / Limitations
Potential adverse effects of daily interruption of sedation:
Any reasonable justifiable approach acceptable.
Daily interruption of sedation may have a role in physiologically stable patients in ICUs that do not routinely use protocolised sedation.
Kress, John P., et al. "Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation." New England Journal of Medicine342.20 (2000): 1471-1477.
Kress, John P., et al. "The long-term psychological effects of daily sedative interruption on critically ill patients." American journal of respiratory and critical care medicine 168.12 (2003): 1457-1461.
Girard, Timothy D., et al. "Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial." The Lancet 371.9607 (2008): 126-134.
Mehta, Sangeeta, et al. "Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial." JAMA 308.19 (2012): 1985-1992.
Burry, L., et al. "Daily sedation interruption versus no daily sedation interruption for critically ill adult patients requiring invasive mechanical ventilation." The Cochrane Library 2014, Issue 7