Sedation, analgesia & delirium · Sedation interruption
Daily sedation interruption in patients cared for with a sedation protocol
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Protocolised sedation plus daily sedation interruption |
| Control | Protocolised sedation alone |
| Population | 430 mechanically ventilated critically ill adults |
| Follow-up | ICU stay |
| Primary endpoint | Time to successful extubation |
| Result | Median time to successful extubation was 7 days in both groups (IQR 4 to 13 versus 3 to 12; hazard ratio 1.08, 95% CI 0.86 to 1.35, p=0.52). ICU length of stay was also similar at a median of 10 days. |
| Secondary endpoints | ICU and hospital length of stay, sedative doses, nurse workload, adverse events |
For mechanically ventilated adults managed with protocolized sedation, the addition of daily sedation interruption did not reduce the duration of mechanical ventilation or ICU stay.
The trial authors, in the published abstract
Does not refute Kress 2000 so much as explain it: the benefit was never the interruption itself but the avoidance of deep continuous sedation. Once light sedation is the default, there is nothing left to interrupt. The same logic explains ROSE against ACURASYS.
Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA 2012 Nov 21;308(19):1985-92.