Recent study of deeply sedated patients compares protocol of hourly assessment alone versus the protocol plus daily sedation interruption. There was nodifference in time to extubation, ICU length of stay, hospital LOS, rate of delirium, or accidental extubation. Daily interruption may not be beneficial over hourly monitoring alone.
Mehta S et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: A randomized controlled trial. JAMA 2012 Oct 17
RCT of 430 critically ill, mechanically ventilated adults in 16 tertiary care medical and surgical ICUs. All patients received continuous opioid and/or benzodiazepine infusions and were randomized to protocolized sedation (n = 209) (control) or to protocolized sedation plus daily sedation interruption. Protocolized sedation involved nurses using standardized scales to assess sedation needs hourly and titrate infusions.
RESULTS: For interruption group v. control group:
- NO DIFFERENCE IN THESE VARIABLES
- Median time to successful extubation: interruption was 7 days (IQR 4-13) v control was 7 days (IQR 3-12)
- Duration of ICU stay: median [IQR] 10 [5-17] vs 10 [6-20]
- Length of stay: median [IQR] 20 [10-36] vs 20 [10-48]
- Rates of delirium: 53.3% in the interruption group vs 54.1% in the control group; relative risk, 0.98; 95% CI, 0.82-1.17; P = .83
- Unintentional endotracheal tube removal: 10 of 214 (4.7%) in interruption group vs 12 of 207 patients (5.8%) in the control group, RR 0.82, p=0.64
DIFFERENCES BETWEEN THE GROUPS FOR THESE VARIABLES
- Mean daily doses of midazolam was higher for the interruption group: 102 mg/d vs 82 mg/d; P = .04 and for fentanyl: median [IQR], 550 [50-1850] vs 260 [0-1400]; P < .001
- Number of daily boluses of benzodiazepines was also higher in the interruption group: mean, 0.253 vs 0.177; P = .007, and for opiates: mean, 2.18 vs 1.79; P < .001
- Nurse workload was greater in the interruption group (VAS score, 4.22 vs 3.80; mean difference, 0.41; 95% CI, 0.17-0.66; P = .001).
Reviewed JKN 4/14
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