Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation.
Sedatives and analgesics are commonly employed in the modern intensive care unit (ICU) for the relief of patient discomfort and anxiety, for amnesia, and the provision of adequate analgesia . Additionally they may be used to reduce respiratory muscle oxygen requirements in severe hypoxemic respiratory failure and to reduce patient-ventilator asynchrony. The most commonly used classes of medications for anxiolysis and relief of agitation are the benzodiazepines . Butyrophenones such as haloperidol and the nonanalgesic sedative propofol are also used for this purpose. Opiates remain the usual drug of choice for analgesia. Frequently these medications are used in combination. Each may be given by continuous intravenous infusion or by intermittent intravenous boluses. Because of the frequent use of these medications and because of the wide choice of medications, combinations of medications, and methods of administration available to the clinician, as well as the complications of overmedication, this is an important area of research in the ICU. Although a review of this topic was published in Intensive Care Medicine less than 2 years ago , a number of important studies on this topic have been published since then. This contribution reviews and discusses three of them. Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, Kollef MH (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27:2609–2615