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 (comment
A Bedside Guide to Mechanical Ventilation



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