Daily Sedative Interruption in Mechanically Ventilated Patients: Limited Data, Numerous Concerns

Abstract

Objective To review the literature regarding daily interruption of sedation in mechanically ventilated patients, the associated clinical outcomes, and the theoretical concerns that remain regarding such practice. Data Sources: A Medline search (1966 to February 2006) was performed using key search terms: critical illness, intensive care units, (analgesics, opioid), hypnotics and sedatives, (infusions, parenteral), drug administration schedule, and sedative interruption. References of identified manuscripts were also evaluated. Study Selection and Data Extraction All English-language articles identified from the data sources were evaluated and deemed relevant if they included an assessment of clinical outcomes. Data Synthesis Continuous IV infusion of analgesics and sedatives is commonly used in critically ill patients to help maintain a constant level of patient comfort. In mechanically ventilated patients, use of continuous IV sedation has been linked to a prolonged duration of mechanical ventilation, as well as a longer ICU and hospital length of stay (LOS). Daily sedative interruption has been shown to reduce the duration of mechanical ventilation, ICU LOS, and incidence of ICU-related complications without causing long-term (post-discharge) psychological sequelae. Although available data are limited, this information may be used to develop ICU sedation protocols in an attempt to minimize the incidence of oversedation and associated complications. Conclusion Daily interruption of continuous IV sedation may hold much promise for optimizing outcomes in the mechanically ventilated critically ill patient. However, theoretical concerns still remain including the practicality and safety of such practice.