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Daily interruptions to sedation for critically ill adults?

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7068 (Published 24 October 2012) Cite this as: BMJ 2012;345:e7068

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Clear protocols help nurses minimise sedation for critically ill adults. The goal is to keep patients comfortable and pain free without prolonging ventilation or increasing the incidence of post-sedation delirium. Some intensive care units also encourage daily interruptions of all sedation, although this strategy may not improve outcomes when added to existing sedation protocols, say researchers from Canada.

In a randomised trial, patients managed with daily interruptions remained intubated for just as long as controls managed without a break (7 days v 7 days; hazard ratio 1.08, 95% CI 0.86 to 1.35). They were no less likely to develop delirium (53.3% v 54.1%; relative risk 0.98, 0.82 to 1.17) and needed significantly more sedatives and analgesics to keep them comfortable. The interruptions increased nurses’ workloads, with no advantage to patients.

Patients in both groups spent a median of 10 days in intensive care and 20 days in hospital; 30% of patients in both groups died.

All patients were lightly sedated using intravenous benzodiazepines and opiates. Nurses used protocols that incorporated sedation scores to titrate infusions every hour. Subgroup analyses hinted at faster weaning for surgical patients managed with daily interruptions, but the numbers in these analyses were small. More than four fifths of participants were admitted as medical emergencies. The two leading diagnoses were pneumonia and sepsis.

Notes

Cite this as: BMJ 2012;345:e7068