title: The significance of sedation control in patients receiving mechanical ventilation.
abstract: BACKGROUND
  Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation.
  
  
  METHODS
  A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS) was conducted in the SAG.
  
  
  RESULTS
  In the SAG, the dose of midazolam was significantly reduced by control of sedation (day 1, 1.3±0.5 µg/kg/min; day 2, 0.9±0.4 µg/kg/min; p<0.01), and was significantly lower than the ECG on day 2 (p<0.01). Likewise, on day 2, sedation levels were significantly lower in the SAG than in the ECG. Significant relationship was found between Ramsay sedation scale and Richmond agitation-sedation scale (RASS; r(s)=-0.57), Ramsay Sedation Scale and Bispectral Index (BIS; r(s)=0.77), and RASS and BIS (r(s)=-0.79). In 10 patients, who didn't require re-sedation after DIS, BIS showed the earliest and most significant changes among the sedation scales. Ventilatory parameters showed significant but less prominent changes, and hemodynamic parameters didn't show significant changes. No seriously adverse events ensued after the implementation of DIS.
  
  
  CONCLUSIONS
  Active assessment and control of sedation significantly reduced the dosage of sedatives in patients receiving mechanical ventilation. DIS, conducted in limited cases, suggested its potential efficacy and tolerability.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Yun Jung
authors.initials: YJ
authors.lastname: Jung
authors.forename: Wou Young
authors.initials: WY
authors.lastname: Chung
authors.forename: Miyeon
authors.initials: M
authors.lastname: Lee
authors.forename: Keu Sung
authors.initials: KS
authors.lastname: Lee
authors.forename: Joo Hun
authors.initials: JH
authors.lastname: Park
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Sheen
authors.forename: Sung Chul
authors.initials: SC
authors.lastname: Hwang
authors.forename: Kwang Joo
authors.initials: KJ
authors.lastname: Park