N Engl J Med. 2000 May 18;342(20):1471-7.
Comment in:
N Engl J Med. 2000 May 18;342(20):1520-2.
N Engl J Med. 2000 Sep 14;343(11):814;
author reply 814-5. N Engl J Med. 2000 Sep 14;343(11):814;
author reply 814-5.
Daily interruption of sedative infusions in critically ill
patients undergoing mechanical ventilation.
Kress JP, Pohlman AS, O'Connor MF, Hall JB.
Department of Medicine, University of Chicago, IL, USA.
BACKGROUND: Conous 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.
Publication Types: Clinical Trial Randomized Controlled Trial
PMID: 10816184 [PubMed - indexed for MEDLINE]
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