Should You Turn Off the Sedating Medications Daily?

Excessive sedation of critically ill patients results in prolonged duration of mechanical ventilation and higher risk for delirium. Two approaches have been used to minimize sedation: daily medication interruptions and protocolized titration of medications (i.e., nurses use standardized scales to assess sedation needs hourly and titrate infusions accordingly).

North American investigators evaluated whether these strategies had an additive effect on time to successful extubation in 423 patients in 16 intensive care units (ICUs) who were receiving continuous infusions of sedating medications and were randomized either to protocolized sedation with daily interruptions or to protocolized sedation alone. Time to extubation was similar in both gro…