Daily interruption of continuous sedation.
Sedatives administered by continuous intravenous infusion are an essential component of the care of patients requiring mechanical ventilation. Delayed awakening from sedation has been associated with prolonged stays in the hospital and the intensive care unit (ICU). Incorporation of a daily sedation interruption policy into a medical ICU guideline has significantly reduced ICU stay and days of mechanical ventilation, and has significantly increased the likelihood of planned extubation compared with no intervention. Furthermore, opioid administration and ICU complications were significantly reduced in patients receiving daily sedation interruption. Lack of long-term deleterious psychiatric effects, such as evidence of posttraumatic stress disorder or recall of events, has been documented with daily sedation interruption during the ICU stay. Resistance to the routine implementation of a daily sedation interruption policy arises from concerns about the need for greater resources and the risk of rebound agitation. The benefits have been documented only in a single center to date. However, the benefit: risk ratio is positive and warrants incorporation of daily sedation interruption into the routine care of patients who are critically ill and require mechanical ventilation.
Wittbrodt
Eric T
ET
Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania 19104, USA. e.wittbr@usip.edu
D016292:Procedural Sedation; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial
D006993:Hypnotics and Sedatives