Should Sedation Be Eliminated for Mechanically Ventilated Patients in Intensive Care?

Daily interruption of sedation — rather than continuous sedation — became an intensive care unit (ICU) standard 20 years ago, after researchers demonstrated fewer mechanical ventilation days and fewer ICU days with interrupted sedation (NEJM JW Gen Med Jul 1 2000 and N Engl J Med 2000; 342:1471). However, whether complete elimination of sedation could benefit mechanically ventilated patients further is unclear. Scandinavian investigators randomized 700 ventilated adult ICU patients to receive (unblinded) either no sedation or light sedation with daily wakening. Nonsedation patients could receive opioid analgesia (if indicated) and could receive sedation for delirium or inability to maintain a natural sleep cycle; 38% of the nonsedation grou…