Sedation holidays during mechanical ventilation
Trial question
What is the effect of daily interruption of sedative infusions in patients undergoing mechanical ventilation?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
53.0% female
47.0% male
N = 128
128 patients (68 female, 60 male).
Inclusion criteria: adult patients receiving mechanical ventilation and continuous infusions of sedative drugs in medical ICU.
Key exclusion criteria: pregnancy, transfer from an outside institution where sedatives had already been administered, and admission after resuscitation from cardiac arrest.
Interventions
N=68 intervention (interruptions of the sedative infusions until the patients were awake, on a daily basis).
N=60 control (continuous infusions, interrupted only at the discretion of the clinicians in the ICU).
Primary outcome
Duration of mechanical ventilation
4.9 days
7.3 days
7.3 days
5.5 days
3.6 days
1.8 days
0.0 days
Intervention
Control
Significant
increase ▲
Significant increase in duration of mechanical ventilation (4.9 days vs. 7.3 days).
Secondary outcomes
Significant increase in length of stay in the ICU (6.4 days vs. 9.9 days).
Significant increase in the rate of days during which patients were awake while receiving a sedative infusion (85.5% vs. 9%; AD 76.5%, 95% CI 31.11 to 121.89).
No significant difference in death in the hospital (36% vs. 46.7%; RR 0.77, 95% CI -0.53 to 2.07).
Safety outcomes
No significant difference in adverse events including removal of endotracheal tube by the patient.
Significant differences in diagnostic testing to assess changes in mental status (9% vs. 27%), non-awake during ICU stay (10.3% vs. 25%).
Conclusion
In adult patients receiving mechanical ventilation and continuous infusions of sedative drugs in medical ICU, intervention was superior to control with respect to duration of mechanical ventilation.
Reference
J P Kress, A S Pohlman, M F O'Connor 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.
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