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2014 ; 4
(ä): 14
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Daily sedative interruption versus intermittent sedation in mechanically
ventilated critically ill patients: a randomized trial
#MMPMID24900938
Nassar Junior AP
; Park M
Ann Intensive Care
2014[]; 4
(ä): 14
PMID24900938
show ga
BACKGROUND: Daily sedative interruption and intermittent sedation are effective
in abbreviating the time on mechanical ventilation. Whether one is superior to
the other has not yet been determined. Our aim was to compare daily interruption
and intermittent sedation during the mechanical ventilation period in a low nurse
staffing ICU. METHODS: Adult patients expected to need mechanical ventilation for
more than 24 hours were randomly assigned, in a single center, either to daily
interruption of continuous sedative and opioid infusion or to intermittent
sedation. In both cases, our goal was to maintain a Sedation Agitation Scale
(SAS) level of 3 or 4; that is patients should be calm, easily arousable or
awakened with verbal stimuli or gentle shaking. Primary outcome was
ventilator-free days in 28 days. Secondary outcomes were ICU and hospital
mortality, incidence of delirium, nurse workload, self-extubation and
psychological distress six months after ICU discharge. RESULTS: A total of 60
patients were included. There were no differences in the ventilator-free days in
28 days between daily interruption and intermittent sedation (median: 24 versus
25 days, P?=?0.160). There were also no differences in ICU mortality (40 versus
23.3%, P?=?0.165), hospital mortality (43.3 versus 30%, P?=?0.284), incidence of
delirium (30 versus 40%, P?=?0.472), self-extubation (3.3 versus 6.7%,
P?=?0.514), and psychological stress six months after ICU discharge. Also, the
nurse workload was not different between groups, but it was reduced on day 5
compared to day 1 in both groups (Nurse Activity Score (NAS) in the intermittent
sedation group was 54 on day 1 versus 39 on day 5, P?0.001; NAS in daily
interruption group was 53 on day 1 versus 38 on day 5, P?0.001). Fentanyl and
midazolam total dosages per patient were higher in the daily interruption group.
The tidal volume was higher in the intermittent sedation group during the first
five days of ICU stay. CONCLUSIONS: There was no difference in the number of
ventilator-free days in 28 days between both groups. Intermittent sedation was
associated with lower sedative and opioid doses. TRIAL REGISTRATION:
ClinicalTrials.gov Identifier: NCT00824239.