Daily sedation “vacations” are a key component of the IHI VAP Bundle and other bundles designed to prevent ventilator-associated pneumonia. Minimizing sedation also helps reduce the incidence of delirium in the intubated, mechanically-ventilated patient. We all recognize there is a tendency to oversedate ICU patients on ventilators. But what about trying no sedation at all?
A group of Danish clinical researchers did just that (Strem 2010). They did a randomized controlled trial in which ICU patients on mechanical ventilation were randomized to receive either no sedation or daily interrupted sedation. They found that patients who received no sedation had significantly fewer days on ventilators, shorter ICU stays, and shorter total hospital LOS. There was no difference in accidental extubations or VAP, though more patients in the no sedation group had agitated delirium.
These results are actually quite encouraging and the practice of eliminating sedation all together may become more widely accepted if these results can be replicated in other settings.
Strem T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. The Lancet 2010; 375: 475 - 480