title: Sedation and analgesia in mechanical ventilation.
abstract: Traditionally, critically ill patients undergoing mechanical ventilation (MV) have received sedation. Over the last decade, randomized controlled trials have questioned continued use of deep sedation. Evidence shows that a nurse-driven sedation protocol reduces length of MV compared with standard strategy with sedation. Furthermore, daily interruption of sedation reduces length of MV, intensive care unit (ICU), and hospital length of stay (LOS). A larger scale trial with daily interruption of sedation has confirmed these findings and furthermore showed a reduction in 1-year mortality with the use of daily interruption of sedation. Recently, a strategy with no sedation has been described reporting a reduction in length of MV, ICU, and hospital LOS compared with a strategy with daily interruption of sedation. Follow-up trials report that reducing sedation does not seem to increase the risk of psychological morbidity. Moreover, delirium has gained increased focus in recent years with development of validated tools to detect both hyperactive and hypoactive forms of delirium. Using validated tools for detecting delirium is important in monitoring and detecting acute brain dysfunction in critically ill patients. Evidence from randomized trials also cites a beneficial effect of early mobilization with respect to length of MV and delirium.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Strøm
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
authors.forename: Palle
authors.initials: P
authors.lastname: Toft
mesh_terms: D000698:Analgesia / Q000379:methods*; D016638:Critical Illness; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007362:Intensive Care Units; D007902:Length of Stay; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods*; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives