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3 A similar trial reported in the Journal showed that mortality was lower and the length of hospital stay shorter among the patients who had daily interruption of sedation than among those who had no interruption. A trial comparing daily interruption of sedation with no interruption showed that patients had shorter durations of mechanical ventilation and shorter stays in the intensive care unit (ICU) with daily interruption. 2 However, trials published in the last two decades have reported that the use of sedatives may worsen outcomes in mechanically ventilated patients. 1 Although advances in technology have made modern ventilators more comfortable for patients, it has generally been believed that light sedation should accompany mechanical ventilation. The practice of sedating patients receiving mechanical ventilation has been standard care. (Funded by the Danish Medical Research Council and others NONSEDA number, NCT01967680.) Introduction ConclusionsĪmong mechanically ventilated ICU patients, mortality at 90 days did not differ significantly between those assigned to a plan of no sedation and those assigned to a plan of light sedation with daily interruption. A major thromboembolic event occurred in 1 patient (0.3%) in the nonsedation group and in 10 patients (2.8%) in the sedation group (difference, −2.5 percentage points 95% CI, −4.8 to −0.7 ).
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The patients in the nonsedation group had a median of 27 days free from coma or delirium, and those in the sedation group had a median of 26 days free from coma or delirium. The number of ICU-free days and of ventilator-free days did not differ significantly between the trial groups.
Mortality at 90 days was 42.4% in the nonsedation group and 37.0% in the sedated group (difference, 5.4 percentage points 95% confidence interval, −2.2 to 12.2 P=0.65). The mean RASS score in the nonsedation group increased from −1.3 on day 1 to −0.8 on day 7 and, in the sedation group, from −2.3 on day 1 to −1.8 on day 7.
The characteristics of the patients at baseline were similar in the two trial groups, except for the score on the Acute Physiology and Chronic Health Evaluation (APACHE) II, which was 1 point higher in the nonsedation group than in the sedation group, indicating a greater chance of in-hospital death. ResultsĪ total of 710 patients underwent randomization, and 700 were included in the modified intention-to-treat analysis. Between-group differences were calculated as the value in the nonsedation group minus the value in the sedation group. Secondary outcomes were the number of major thromboembolic events, the number of days free from coma or delirium, acute kidney injury according to severity, the number of ICU-free days, and the number of ventilator-free days. The primary outcome was mortality at 90 days. In a multicenter, randomized, controlled trial, we assigned, in a 1:1 ratio, mechanically ventilated ICU patients to a plan of no sedation (nonsedation group) or to a plan of light sedation (i.e., to a level at which the patient was arousable, defined as a score of −2 to −3 on the Richmond Agitation and Sedation Scale, on which scores range from −5 to +4 ) (sedation group) with daily interruption. Data on whether a plan of no sedation, as compared with a plan of light sedation, has an effect on mortality are lacking. In critically ill, mechanically ventilated patients, daily interruption of sedation has been shown to reduce the time on ventilation and the length of stay in the intensive care unit (ICU). The most trusted, influential source of new medical knowledge and clinical best practices in the world.
Missing information half life 2 download license#
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