title: Low tidal volume ventilation does not increase sedation use in patients with acute lung injury.
abstract: OBJECTIVE
  Low tidal volume ventilation is associated with reduced mortality in patients with acute lung injury, yet concerns exist about patient comfort and the levels of sedation and analgesia required during its use. We compared the doses and duration of sedatives and opioid analgesics in patients receiving low vs. traditional tidal volumes at our institution.
  
  
  METHODS
  Secondary analysis of a randomized clinical trial.
  
  
  METHODS
  University-affiliated county hospital in Seattle, WA.
  
  
  METHODS
  Sixty-one patients with acute lung injury enrolled in the National Heart, Lung and Blood Institute's ARDS Network tidal volume trial.
  
  
  METHODS
  None.
  
  
  RESULTS
  Thirty-three patients were randomized to the lower tidal volume arm (6 mL/kg of predicted body weight) and 28 patients were randomized to the higher tidal volume arm (12 mL/kg of predicted body weight). There were no significant differences in the percentage of study days patients received sedatives, opioids, or neuromuscular blockade. When specific study days were examined, there were no significant differences in the proportion of patients receiving benzodiazepines, propofol, haloperidol, and opioids on days 1, 2, 3, and 7 of mechanical ventilation, nor were there differences in the doses of benzodiazepines and opioids on those days.
  
  
  CONCLUSIONS
  At our institution, low tidal volume ventilation was not associated with increased dose or duration of sedatives in patients with acute lung injury. Sedation administration should not be considered a barrier to implementing a lung-protective ventilation strategy.
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
authors.forename: Liane
authors.initials: L
authors.lastname: Andersson
authors.forename: Veena
authors.initials: V
authors.lastname: Karir
authors.forename: Nayak L
authors.initials: NL
authors.lastname: Polissar
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Neff
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001569:Benzodiazepines / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control; D015742:Propofol / Q000008:administration & dosage; D012121:Respiration, Artificial / Q000379:methods* / Q000706:statistics & numerical data*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D013990:Tidal Volume
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D015742:Propofol