Background Continuous infusions of sedative drugs in the intensivecare unit may prolong the duration of mechanical ventilation,prolong the length of stay in the intensive care unit and thehospital, impede efforts to perform daily neurologic examinations,and increase the need for tests to assess alterations in mentalstatus. Whether regular interruption of such infusions mightaccelerate recovery is not known.
Methods We conducted a randomized, controlled trial involving128 adult patients who were receiving mechanical ventilationand continuous infusions of sedative drugs in a medical intensivecare unit. In the intervention group, the sedative infusionswere interrupted until the patients were awake, on a daily basis;in the control group, the infusions were interrupted only atthe discretion of the clinicians in the intensive care unit.
Results The median duration of mechanical ventilation was 4.9days in the intervention group, as compared with 7.3 days inthe control group (P=0.004), and the median length of stay inthe intensive care unit was 6.4 days as compared with 9.9 days,respectively (P=0.02). Six of the patients in the interventiongroup (9 percent) underwent diagnostic testing to assess changesin mental status, as compared with 16 of the patients in thecontrol group (27 percent, P=0.02). Complications (e.g., removalof the endotracheal tube by the patient) occurred in three ofthe patients in the intervention group (4 percent) and fourof 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 theduration of mechanical ventilation and the length of stay inthe 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.
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