Sedation, analgesia & delirium · Sedation interruption
Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation
| Design | Randomised controlled trial |
|---|---|
| Treatment | Daily interruption of sedative infusions until the patient was awake |
| Control | Interruption at the clinician's discretion |
| Population | 128 mechanically ventilated adults receiving continuous sedative infusions |
| Follow-up | ICU stay |
| Primary endpoint | Duration of mechanical ventilation |
| Result | Median duration of mechanical ventilation was 4.9 days with daily interruption versus 7.3 days in the control group (p=0.004), and median ICU stay 6.4 versus 9.9 days. Complications such as self-extubation occurred in 3 of the intervention group (4%) and 4 of the control group (7%), p=0.88. |
| Secondary endpoints | ICU length of stay, diagnostic testing for altered mental status, complications |
In patients who are receiving mechanical ventilation, daily interruption of sedative-drug infusions decreases the duration of mechanical ventilation and the length of stay in the intensive care unit.
The trial authors, in the published abstract
The origin of the sedation hold, and a founding component of modern ICU liberation bundles alongside Wake up and breathe. Its effect was largest against a comparator of deep continuous sedation, which is why SLEAP found nothing once protocolised light sedation became standard.
Kress JP, Pohlman AS, O'Connor MF, et al. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000 May 18;342(20):1471-7.