Thomas Strom and colleagues are to be congratulated on doing a trial in a challenging area.They showthat a no-sedation strategy results in a shorter length of mechanical ventilation than does a strategy of daily sedation interruption. We respectfully believe, however, that there may be a more pharmacologically plausible explanation for their observations.Their trial could equally be interpreted as a "midazolam" versus "no midazolam" study. Although Stram and colleagues do mention the possibility of longer sedation with midazolam in their Discussion, it is dismissed by reference to the study by Kress and colleagues. Yet, in that study, the patient groups were much younger, fitter, less severely ill, and received less total exposure to midazolam than those in Stram and colleagues'trial.
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