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Structured abstractQuestionDoes daily interruption of sedative infusions in critically ill patients receiving mechanical ventilation decrease the duration of mechanical ventilation and length of stay in the intensive care unit (ICU) and hospital?PopulationThis study investigated intubated patients in the medical ICU of the University of Chicago Hospital. The study coordinators enrolled 150 patients who required sedation for agitation or discomfort according to the treating ICU team. Amongst the 150 patients enrolled, the 128 patients who were ultimately included in the study were those who were still alive and intubated after the initial 48 hr in the ICU. The study excluded patients who were pregnant, already receiving sedatives upon transfer to the ICU, or who were post-cardiac arrest.InterventionPatients were randomly assigned to receive one of two sedation infusion strategies. The treatment group had sedation medications stopped daily. A study nurse then observed these patients until they awoke. A study physician was then summoned to restart the sedative medications at half their previous dose and then retitrate to the desired effect (Ramsay level 3–4 on a 1–6 scale). The control group received “routine care” of the rounding ICU team. Both of these treatment groups had their patients either assigned to midazolam or propofol as the sedative agent, making a total of four different treatment groups.Outcomes of interestThe primary outcomes were the lengths of time with mechanical ventilation, in the ICU and in the hospital. Secondary outcomes included adverse events (e.g., premature self-extubation, reintubation, long-term ventilation, withdrawal of care and death).For the daily interruption group, the number of days intubated and in the ICU was significantly lower, and there was a trend toward fewer hospital days (Figure). Furthermore, there were fewer diagnostic studies done for the intervention group to determine the cause of a change in mental status. Other secondary outcomes did not differ between the groups. No important differences were seen with regards to which sedative agent was used.ConclusionIntubated medical ICU patients who receive daily interruption of sedative infusions have shorter times on the ventilator and in the ICU.

Best evidence in critical care medicine