Daily Stopping of Sedation in ICU Patients Promising
Leads to less ventilator time, shorter ICU stays, lower mortality
FRIDAY, Jan. 11 (HealthDay News) -- Among mechanically ventilated, critically ill patients, a daily period of interruption of sedation paired with a spontaneous breathing trial (SBT) leads to fewer days spent on the ventilator, shorter intensive care unit (ICU) and hospital stays, and reduced mortality compared to patients treated with daily SBTs alone, reports an article published in the Jan. 12 issue of The Lancet.
Timothy D. Girard, M.D., of the Vanderbilt University School of Medicine in Nashville, Tenn., and colleagues randomly assigned 336 mechanically ventilated patients in ICUs in four tertiary-care hospitals to receive a daily spontaneous awakening trial followed by a SBT, or to receive usual sedation plus a daily SBT.
During the 28-day study period, patients in the intervention group spent more time breathing spontaneously than those in the control group (14.7 days versus 11.6 days) and were discharged earlier from the ICU (median ICU time 9.1 days versus 12.9 days) and the hospital (median stay 14.9 days versus 19.2 days). In addition, the risk of death during the year following enrollment was lower in the intervention group (hazard ratio 0.68).
Despite these promising results, the author of an associated editorial warns about potential methodologic flaws in the study and calls for more research. "Uncertainties about the control group in this study, and about the resources needed for implementation, mean that more information is needed to show that the approach is feasible and safe in everyday practice," the editorialist concludes.