Circumventing Sedation Reduces Mechanical Ventilation Time

All patients received intravenous (IV) morphine boluses as needed and IV haloperidol for delirium, but no physical restraints were used. If possible, the patients were sat in a chair each day. Excluding those patients who died or were extubated within less than 48 hours of ventilation, 55 patients in the no-sedation group and 58 in the sedation group remained for intent-to-treat analysis.

The results showed that after 4 weeks, the sedation group had significantly more days on mechanical ventilation the no-sedation group ((13.8 versus 9.6 days, respectively). In addition, the sedated patients averaged more days in the ICU (22.8 versus 13.1 days) and longer overall hospital stays (58 versus 34 days); however, once patients were in the ICU for longer than 30 days, sedation no longer affected total ICU length of stay. The researchers observed no significant differences between groups in accidental removal of the endotracheal tube, need for brain imaging, or incidence of ventilator-associated pneumonia. Overall, 18% of patients in the no-sedation group could not tolerate it and had to receive continuous sedation on more than two occasions, typically to permit sufficient oxygenation in a severe acute respiratory distress syndrome (ARDS) episode. The only negative impact of the no-sedation strategy appeared to be an increase in agitated delirium (20% versus 7%) resulting in more frequent use of haloperidol. The study was published in the February 6, 2010, issue of the Lancet.

"I think most importantly one needs to evaluate the patients' needs each day; make sure they are comfortable and free of pain and only give sedation as a last escape,” said lead author Thomas Strøm, M.D., of the department of anesthesia and intensive care medicine.

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