No sedation for mechanical ventilation
The standard practice for mechanical ventilation on an intensive care
unit (ICU) is to sedate the patient. Studies of daily interruption of
sedation have shown that it reduces the duration of mechanical
ventilation, possibly reduces the risk of post-traumatic stress
disorder, and reduces the risks of ventilator-associated pneumonia,
upper gastrointestinal bleeding, bacteraemia, barotraumas, venous
thromboembolism, cholestasis, and severe sinusitis.
In Odense, Denmark, the practice since 1999 has been to give
intravenous morphine but no sedatives or analgesics. Now, researchers
there have compared no sedation (NS) with daily interrupted sedation
(DIS).
A total of 140 patients on mechanical ventilation were randomized to NS
or DIS with propofol for 48 hours and then midazolam. Bolus doses of
morphine were given in both groups. The analysis included 113 patients.
In the first 28 days the mean number of days without ventilation was
13.8 days (NS) vs 9.6 days (DIS), a significant difference. NS was also
significantly associated with a shorter stay in ICU and in hospital.
Agitated delirium was more frequent in the NS group (20% vs 7%). The
groups did not differ significantly in the frequency of accidental
extubation, ventilator-associated pneumonia, or requests for CT o MRI
brain scans.
The NS policy appeared to be advantageous. A multicentre study is called for.
Strøm T et al. A protocol of no sedation for critically ill patients
receiving mechanical ventilation: a randomized trial. Lancet 2010;
375:475–480; Brochard L. Less sedation in intensive care: the pendulum
swings back. Ibid: 436–438 (commentA Bedside Guide to Mechanical Ventilation IF YOU WANT YO BUY IT ..READ SOME PAGES FirstSearch inside this book
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