Daily interruption of sedative infusions in an adult medical-surgical  intensive care unit: randomized controlled trial.
OBJECTIVE
This article is a report of a study conducted to determine if a nursing-implemented protocol of daily interruption of sedative infusions vs. sedation as directed by the intensive care unit team would decrease duration of mechanical ventilation.


BACKGROUND
Continuous rather than intermittent infusion of sedative and analgesic agents leads to greater stability in sedation level, but has been correlated with prolongation of mechanical ventilation and hospitalization of critical care patients. Daily interruption of sedative infusions in mechanically ventilated patients has reduced the duration of mechanical ventilation and length of stay in intensive care.


METHODS
A randomized controlled trial was carried out from November 2004 to March 2006 with 97 patients receiving mechanical ventilation and continuous infusion of sedative drugs in an intensive care unit in Greece. The primary outcome measure was the duration of mechanical ventilation. Secondary outcomes were length of intensive care unit stay, length of hospital stay, overall mortality, total doses of sedative and analgesic medicines and Ramsay scores and duration of cessation of sedative infusions per day.


RESULTS
The median duration of mechanical ventilation was 8.7 days vs. 7.7 days (P = 0.7). Length of intensive care unit stay (median: 14 vs. 12, P = 0.5) and in the hospital (median: 31 vs. 21, P = 0.1) was similar between the intervention and control groups. The absence of statistically significant differences in these variables remained when patients with brain injury were examined separately.


CONCLUSIONS
The nursing-implemented protocol of daily interruption of sedative infusions was neither beneficial nor harmful compared with usual practice, which has as its primary target the earliest possible awakening of patients.
Anifantaki
Stella
S
Intensive Care Unit, University Hospital of Heraklion, Crete, Greece. stellan8@gmail.com
Prinianakis
Georgios
G
Vitsaksaki
Efsevia
E
Katsouli
Victoria
V
Mari
Stella
S
Symianakis
Antonios
A
Tassouli
Georgia
G
Tsaka
Eleni
E
Georgopoulos
Dimitris
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000627:therapeutic use*; D015742:Propofol / Q000627:therapeutic use*; D000077208:Remifentanil; D012121:Respiration, Artificial / Q000379:methods / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods; D055815:Young Adult
D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol