Sedation interruption does not reduce mechanical ventilation duration

Daily sedative interruption of mechanically ventilated patients in intensive care units (ICUs) does not reduce the time they are on ventilation or improve their clinical outcomes, report researchers in JAMA.

Furthermore, patients in their study who were randomly assigned to this strategy on top of their protocolized sedation treatment received more opioids and benzodiazepines, and incurred a greater self-assessed nurse workload, compared with those who received protocolized sedation alone.

"Critically ill patients wean more quickly from mechanical ventilation, with lower risk for delerium, when clinicians use specific strategies to reduce excessive sedation," explain Sangeeta Mehta (Mount Sinai Hospital, Toronto, Ontario, Canada) and colleagues.

Therefore, the findings of no additional benefits, and the emergence of potential drawbacks for sedation interruption alongside protocolized sedation, "are of uncertain clinical importance," remarks the team.

A total of 16 Canadian and US centers took part in the study between January 2008 and July 2011. In all, 430 critically ill, mechanically ventilated adults on continuous opioid and/or benzodiazepine infusions were randomly assigned to receive protocolized sedation alone (n=209, control group) or in combination with sedation interruption on a daily basis, as indicated by eye opening, tracking, hand squeezing, and toe moving (n=214 intervention group).

The median time to the study endpoint of successful extubation was 7 days in both the control and intervention groups, report Mehta et al. This did not differ after adjustment for age, body mass index, Acute Physiology and Chronic Health Evaluation II score, and admission type.

Overall lengths of hospital stay, mortality, unintentional device removal, and delirium were also similar between groups. However, mean daily benzodiazepine doses, number of boluses per day, and daily opioid doses were higher among the intervention group, at 102 versus 82 mg/day, 0.253 versus 0.177, and 1780 versus 1070 µg/day, respectively.

Nurse workload, assessed using the visual analog score, was also significantly higher in the intervention than the control group, at 4.22 versus 3.80.

Unexpectedly, note the researchers, when data were analyzed separately for surgical and medical patient subgroups, time to extubation was significantly shorter in the intervention group than the control group among surgery patients, at 6 compared with 13 days, while no difference was observed for medical patients.

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