Daily Sedation Interruption in Mechanically Ventilated Critically Ill Patients Cared for With a Sedation Protocol

Abstract

clinicaltrials.gov Identifier: NCT00675363.

Optimizing the approach to pain, agitation, and delirium in critical care

“…They concluded that ''The effectiveness of any new intervention to minimize sedation likely depends on the local usual care.'' 12 Interestingly, in the current report 6 (as stated above), only 22% of all sedative and opioid infusions were stopped and resumed as part of a planned daily interruption strategy (most were stopped in preparation for extubation or neurological assessment). This occurred despite the fact that these data were collected after the publication of the earlier trials suggesting that daily interruption was beneficial 7,9 but prior to the publication of the SLEAP trial 12 which showed no benefit.…”

“…10,11 The largest RCT to test daily interruption of sedation was the SLEAP study 12 that randomized 430 patients in 16 Canadian and United States centres using protocolized sedation in all patients. In this trial, patients randomized to daily sedation interruption required more daily boluses and higher mean doses of opiates and benzodiazepines, and they did not achieve a reduction in the duration of mechanical ventilation or ICU length of stay.…”

“…Leur conclusion était que « l'efficacité de n'importe quelle intervention destinée à minimiser la sédation dépend probablement des soins habituels locaux » . 12 Il est intéressant de noter que, dans la présente publication, 6 seulement 22 % de toutes les perfusions de sédatifs et d'opioïdes ont été arrêtées et reprises dans le cadre d'une stratégie planifiée d'interruption quotidienne (comme indiqué plus haut); la plupart des perfusions ont été arrêtées en préparation de l'extubation ou pour une évaluation neurologique. Cela a eu lieu bien que ces données aient été recueillies après la publication des études précédentes suggérant que l'interruption quotidienne était bénéfique, 7,9 mais avant la publication de l'étude SLEAP 12 qui ne montrait aucun bénéfice.…”

Parallel Pilot Trials of Screening Frequency for Liberation from Mechanical Ventilation the RELEASE Trial and SENIOR Trial Protocols

“…[2] Evaluate clinician compliance with 'once daily' versus 'at least twice daily' screening assessments and the potential for contamination in the 'once daily' arm, [3] Assess current practices related to sedation, analgesia and delirium management, and mobilization before conducting 'once daily' or 'at least twice daily screening' assessments of weaning readiness to quantify potential factors that may lead to performance bias in the future, planned, large scale weaning trial [4] Identify barriers (clinician and institutional) to recruitment into this study. [5] Classify trial participants as requiring (i) simple, (ii) difficult or (iii) prolonged weaning using the 'Task Force on Weaning' definitions [34].…”

Tolerance to sedative drugs in PICU: can it be moderated or is it immutable?

“…The value of DSI [5][6][7] remains unclear. The results of this current study could simply reflect the strong history in the Netherlands of good sedation practice including a relative sparing use of sedatives.…”