2012 Volume 19 Issue 2 Pages 165-175
Background: Patients in the intensive care unit (ICU) often receive sedation and analgesia. Protocolized sedation and daily interruption of sedation are two major examples of sub-optimal sedation practice. To achieve better understanding of the clinical effects on outcomes, we performed a systematic review of randomized controlled trials (RCTs). Methods: We searched the MEDLINE database from January 1990 to October 2010 for English-language RCTs assessing the impact of protocolized sedation or daily interruption of sedation on outcomes among critically ill patients requiring mechanical ventilation for >24 h. Results: Eight RCTs showed that protocolized sedation or daily sedation interruption reduced the duration of mechanical ventilation by 8.2% and ICU stay by 15.3%, but did not reduce mortality compared with standard practice. Daily interruption of sedation, however, has less benefit compared to protocolized sedation in terms of duration of mechanical ventilation and increases the risk of self-extubation and acute coronary syndrome. Conclusions: Protocolized sedation and daily interruption of sedation decrease the duration of mechanical ventilation and ICU stay. Weak evidence suggested the superiority of protocolized sedation over daily interruption of sedation based on adverse events due to daily interruption of sedation.
