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Previous Volume 342:1471-1477 May 18, 2000 Number 20 Next

	Full Text PDF Editorial by Heffner, J. E. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Continuous 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.

Source Information

From the Department of Medicine, Section of Pulmonary and Critical Care (J.P.K., A.S.P., J.B.H.), and the Department of Anesthesia and Critical Care (M.F.O., J.B.H.), University of Chicago, Chicago.

Address reprint requests to Dr. Hall at the University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, MC 6026, Chicago IL 60637, or at jhall{at}medicine.bsd.uchicago.edu.

Full Text of this Article

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Daily Interruption of Sedative Infusions in Critically Ill Patients
Hong J. J., Mazuski J. E., Shapiro M. J., Riker R. R., Fraser G. L., Kress J. P., Hall J. B.
Extract | Full Text  
N Engl J Med 2000; 343:814-815, Sep 14, 2000. Correspondence

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• Hunter, J D (2006). Ventilator associated pneumonia.. Postgrad. Med. J. 82: 172-178 [Abstract] [Full Text]  
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• De Jong, M. M. J., Burns, S. M., Campbell, M. L., Chulay, M., Grap, M. J., Pierce, L. N.B., Simpson, T. (2005). Development of the American Association of Critical-Care Nurses' Sedation Assessment Scale for Critically Ill Patients. Am J Crit Care 14: 531-544 [Abstract] [Full Text]  
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• Roustan, J.-P., Valette, S., Aubas, P., Rondouin, G., Capdevila, X. (2005). Can Electroencephalographic Analysis Be Used to Determine Sedation Levels in Critically Ill Patients?. Anesth. Analg. 101: 1141-1151 [Abstract] [Full Text]  
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• Weissman, C. (2005). Sedation and Neuromuscular Blockade in the ICU. Chest 128: 477-479 [Full Text]  
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• Green, T., Gidron, Y., Friger, M., Almog, Y. (2005). Relative-Assessed Psychological Factors Predict Sedation Requirement in Critically Ill Patients. Psychosom. Med. 67: 295-300 [Abstract] [Full Text]  
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• Jackson, W L Jr, Gallagher, C, Myhand, R C, Waselenko, J K (2005). Medical management of patients with multiple organ dysfunction arising from acute radiation syndrome. Br. J. Radiol. Supplement_27: 161-168 [Abstract] [Full Text]  
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• Weinert, C., McFarland, L. (2004). The State of Intubated ICU Patients: Development of a Two-Dimensional Sedation Rating Scale for Critically Ill Adults. Chest 126: 1883-1890 [Abstract] [Full Text]  
• Haenggi, M., Ypparila, H., Takala, J., Korhonen, I., Luginbuhl, M., Petersen-Felix, S., Jakob, S. M. (2004). Measuring Depth of Sedation with Auditory Evoked Potentials During Controlled Infusion of Propofol and Remifentanil in Healthy Volunteers. Anesth. Analg. 99: 1728-1736 [Abstract] [Full Text]  
• Restrepo, R. D., Fortenberry, J. D., Spainhour, C., Stockwell, J., Goodfellow, L. T. (2004). Protocol-Driven Ventilator Management in Children: Comparison to Nonprotocol Care. J Intensive Care Med 19: 274-284 [Abstract]  
• Vincent, J.-L. (2004). Evidence-Based Medicine in the ICU: Important Advances and Limitations. Chest 126: 592-600 [Abstract] [Full Text]  
• Schrier, R. W., Wang, W. (2004). Acute Renal Failure and Sepsis. NEJM 351: 159-169 [Full Text]  
• Brattebo, G, Hofoss, D, Flaatten, H, Muri, A K, Gjerde, S, Plsek, P E (2004). Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit. Qual Saf Health Care 13: 203-205 [Abstract] [Full Text]  
• Rodriguez, R. A. (2004). Human Auditory Evoked Potentials in the Assessment of Brain Function During Major Cardiovascular Surgery. SEMIN CARDIOTHORAC VASC ANESTH 8: 85-99 [Abstract]  
• Nirmalan, M., Dark, P. M., Nightingale, P., Harris, J. (2004). Editorial IV: Physical and pharmacological restraint of critically ill patients: clinical facts and ethical considerations. Br J Anaesth 92: 789-792 [Full Text]  
• Walsh, T. S., Dodds, S., McArdle, F. (2004). Evaluation of simple criteria to predict successful weaning from mechanical ventilation in intensive care patients. Br J Anaesth 92: 793-799 [Abstract] [Full Text]  
• Ely, E. W., Shintani, A., Truman, B., Speroff, T., Gordon, S. M., Harrell, F. E. Jr, Inouye, S. K., Bernard, G. R., Dittus, R. S. (2004). Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit. JAMA 291: 1753-1762 [Abstract] [Full Text]  
• El-Solh, A. A. (2004). Clinical Approach to the Critically Ill, Morbidly Obese Patient. Am. J. Respir. Crit. Care Med. 169: 557-561 [Full Text]  
• Rodrigo, G. J., Rodrigo, C., Hall, J. B. (2004). Acute Asthma in Adults: A Review. Chest 125: 1081-1102 [Abstract] [Full Text]  
• Kress, J. P., Gehlbach, B., Lacy, M., Pliskin, N., Pohlman, A. S., Hall, J. B. (2003). The Long-term Psychological Effects of Daily Sedative Interruption on Critically Ill Patients. Am. J. Respir. Crit. Care Med. 168: 1457-1461 [Abstract] [Full Text]  
• Amato, M., Brochard, L., Stewart, T., Brower, R., Eichacker, P. Q., Banks, S. M., Natanson, C. (2003). Metaanalysis of Tidal Volume in ARDS. Am. J. Respir. Crit. Care Med. 168: 612-613 [Full Text]  
• Olson, D. M., Chioffi, S. M., Macy, G. E., Meek, L. G., Cook, H. A. (2003). Potential Benefits of Bispectral Index Monitoring in Critical Care: A Case Study. Crit Care Nurse 23: 45-52 [Full Text]  
• Angus, D. C., Crowther, M. A. (2003). Unraveling Severe Sepsis: Why Did OPTIMIST Fail and What's Next?. JAMA 290: 256-258 [Full Text]  
• de Wit, M., Epstein, S. K. (2003). Administration of Sedatives and Level of Sedation: Comparative Evaluation via the Sedation-Agitation Scale and the Bispectral Index. Am J Crit Care 12: 343-348 [Abstract] [Full Text]  
• Ferrer, M., Esquinas, A., Arancibia, F., Bauer, T. T., Gonzalez, G., Carrillo, A., Rodriguez-Roisin, R., Torres, A. (2003). Noninvasive Ventilation during Persistent Weaning Failure: A Randomized Controlled Trial. Am. J. Respir. Crit. Care Med. 168: 70-76 [Abstract] [Full Text]  
• Ely, E. W., Truman, B., Shintani, A., Thomason, J. W. W., Wheeler, A. P., Gordon, S., Francis, J., Speroff, T., Gautam, S., Margolin, R., Sessler, C. N., Dittus, R. S., Bernard, G. R. (2003). Monitoring Sedation Status Over Time in ICU Patients: Reliability and Validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 289: 2983-2991 [Abstract] [Full Text]  
• Bryan-Brown, C. W., Dracup, K. (2003). More. Am J Crit Care 12: 185-187 [Full Text]