Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation

May 18, 2000The New England journal of medicine

Daily breaks from sedative drugs in critically ill patients on breathing machines

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Abstract

The median duration of mechanical ventilation was 4.9 days with daily interruption of sedative infusions compared to 7.3 days without.

Daily interruption of sedative infusions is associated with a shorter duration of mechanical ventilation.
Patients in the intervention group had a median length of stay in the intensive care unit of 6.4 days, compared to 9.9 days in the control group.
Fewer patients in the intervention group required diagnostic testing for changes in mental status (9 percent) compared to the control group (27 percent).
Complications related to the interruption of sedative infusions were low and similar between both groups.

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BACKGROUND: Conous infusions of sedative drugs in the intensive care unit may prolong the duration of mechanical ventilation, prolong the length of stay in the intensive care unit and the hospital, impede efforts to perform daily neurologic examinations, and increase the need for tests to assess alterations in mental status. Whether regular interruption of such infusions might accelerate recovery is not known.

METHODS: We conducted a randomized, controlled trial involving 128 adult patients who were receiving mechanical ventilation and continuous infusions of sedative drugs in a medical intensive care unit. In the intervention group, the sedative infusions were interrupted until the patients were awake, on a daily basis; in the control group, the infusions were interrupted only at the discretion of the clinicians in the intensive care unit.

RESULTS: The median duration of mechanical ventilation was 4.9 days in the intervention group, as compared with 7.3 days in the control group (P=0.004), and the median length of stay in the intensive care unit was 6.4 days as compared with 9.9 days, respectively (P=0.02). Six of the patients in the intervention group (9 percent) underwent diagnostic testing to assess changes in mental status, as compared with 16 of the patients in the control group (27 percent, P=0.02). Complications (e.g., removal of the endotracheal tube by the patient) occurred in three of the patients in the intervention group (4 percent) and four of the patients in the control group (7 percent, P=0.88).

CONCLUSIONS: In patients who are receiving mechanical ventilation, daily interruption of sedative-drug infusions decreases the duration of mechanical ventilation and the length of stay in the intensive care unit.

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Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation

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