Daily Sedation Interruption in Mechanically Ventilated Critically III Patients Cared for With a Sedation Protocol-A Randomized Controlled Trial

摘要

Context Protocolized sedation and daily sedation interruption are 2 strategies to minimize sedation and reduce the duration of mechanical ventilation and intensive care unit (ICU) stay. We hypothesized that combining these strategies would augment the benefits. Objective To compare protocolized sedation with protocolized sedation plus daily sedation interruption in critically ill patients. Design, Setting, and Patients Randomized controlled trial of 430 critically ill, mechanically ventilated adults conducted in 16 tertiary care medical and surgical ICUs in Canada and the United States between January 2008 and July 2011. Intervention Continuous opioid and/or benzodiazepine infusions and random allocation to protocolized sedation (n=209) (control) or to protocolized sedation plus daily sedation interruption (n=214). Using validated scales, nurses titrated infusions to achieve light sedation. For patients receiving daily interruption, nurses resumed infusions, if indicated, at half of previous doses. Patients were assessed for delirium and for readiness for unassisted breathing. Main Outcome Measure Time to successful extubation. Secondary outcomes included duration of stay, doses of sedatives and opioids, unintentional device removal, delirium, and nurse and respiratory therapist clinical workload (on a 10-point visual analog scale [VAS]).