A new study published in the journal JAMA reveals that daily sedation interruption in critically ill patients did not reduce the duration they are needed to be placed on mechanical ventilation nor did it provide any other benefits to the patients, instead increasing analgesic use and nurse workload.
The study is being published early online to coincide with its presentation at the European Society of Intensive Care Medicine Annual Congress.
"Critically ill patients wean more quickly from mechanical ventilation, with lower risk of delirium, when clinicians use specific strategies to reduce excessive sedation, according to background information in the article. "Protocolized sedation and daily sedative interruption are 2 strategies to minimize sedation and reduce the duration of mechanical ventilation and intensive care unit (ICU) stay."
The median (midpoint) time to successful extubation (removal from mechanical ventilation) was 7 days in both groups. The researchers found that there were no significant between-group differences in ICU or hospital lengths of stay, hospital mortality, rates of unintentional device removal, delirium, ICU neuroimaging, tracheostomy, or organ dysfunction. Daily sedation interruption was associated with higher average daily doses of midazolam and fentanyl, and more daily boluses of benzodiazepines and opiates.
Overall, average Sedation-Agitation Scale scores per patient were similar in the 2 groups. However, nurse workload was significantly higher in the interruption group.
"In this multicenter randomized trial, we found that among mechanically ventilated patients receiving continuous sedation, the combined use of protocolized sedation and daily sedative interruption did not improve on the clinical outcomes observed with protocolized sedation alone. Patients in the daily interruption group received more opioids and benzodiazepines, and self-assessed nursing workload was higher for patients in the daily interruption group than the control group; however, these findings are of uncertain clinical importance," the authors write.