title: Patient-ventilator asynchrony during daily interruption of sedation versus no sedation protocol.
abstract: BACKGROUND
  Daily interruption of sedation could minimize the problem of sedatives accumulation. Nevertheless, whatever is the sedation strategy; sedation, particularly deep levels, has been associated with high frequency of patient-ventilator asynchrony. Extending these findings, one would expect that no sedation protocol could reduce the frequency of patient-ventilator asynchrony.
  
  
  OBJECTIVE
  To assess the effect of no sedation protocol compared with daily interruption of sedation on patient-ventilator asynchrony in surgical intensive care patients.
  
  
  METHODS
  The study included 230 patients who expected to require mechanical ventilation for more than 48 h. They were randomized to receive either continuous sedation (1 mg/mL midazolam) to achieve a Ramsay score of 3-4 with daily interruption until awake (group D; n = 115), or no sedation (group N; n = 115). Both groups received bolus doses of morphine (2.5-5 mg) as needed to achieve a score of ≤2 on behavioral pain scale.
  
  
  RESULTS
  No sedation was associated with significantly lower ineffective triggering and asynchrony index but significantly higher double triggering. Patient's effort during triggering was significantly higher during no sedation. The respiratory rate increased and the PaCO2 decreased significantly in no sedation group.
  
  
  CONCLUSIONS
  No sedation protocol reduces the asynchrony index and preserves the patient's effort during triggering.
authors.affiliation: Department of Anesthesia and SICUD, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Ahmed Sobhy
authors.initials: AS
authors.lastname: Bassuoni
authors.affiliation: Department of Anesthesia and SICUD, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Ahmed Said
authors.initials: AS
authors.lastname: Elgebaly
authors.affiliation: Department of Anesthesia and SICUD, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Ahmed Ali
authors.initials: AA
authors.lastname: Eldabaa
authors.affiliation: Department of Anesthesia and SICUD, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Ahmed Ali Abd
authors.initials: AA
authors.lastname: Elhafz
keywords: Asynchrony; daily interruption; patient-ventilator; sedation; sedation protocol