Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation

Background: Continuous infusions of sedative drugs in the intensive care un it may prolong the duration of mechanical ventilation, prolong the length o f stay in the intensive care unit and the hospital, impede efforts to perfo rm daily neurologic examinations, and increase the need for tests to assess alterations in mental status. Whether regular interruption of such infusio ns might accelerate recovery is not known. Methods: We conducted a randomized, controlled trial involving 128 adult pa tients who were receiving mechanical ventilation and continuous infusions o f sedative drugs in a medical intensive care unit. In the intervention grou p, the sedative infusions were interrupted until the patients were awake, o n 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 chang es in mental status, as compared with 16 of the patients in the control gro up (27 percent, P=0.02). Complications (e.g., removal of the endotracheal t ube by the patient) occurred in three of the patients in the intervention g roup (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 in terruption of sedative-drug infusions decreases the duration of mechanical ventilation and the length of stay in the intensive care unit. (N Engl J Me d 2000;342:1471-7.) (C)2000, Massachusetts Medical Society.