Efficacy of sedation vacations in mechanically ventilated critically ill patients

Abstract

Prolonged mechanical ventilation might have negative effects on patients' recovery and increase the risk of complications such as ventilator-associated pneumonia (Schweickert et al., 2004). Sedation vacations have been suggested to decrease serum drug accumulation which in turn can reduce the total length of mechanical ventilation by allowing clinicians to identify patients' readiness for extubation. Research question and PICO framework: The research question proposed for this literature review is if sedation vacations, also referred to as daily sedation interruption (DSI) or sedation breaks are effective in decreasing mechanical ventilation. The PICO framework utilized focused on mechanically ventilated critically ill patients (P = population), undergoing sedation vacations (I= intervention) or standard sedation management (C= comparison) in order to assess which intervention is more effective in decreasing the total length of mechanical ventilation (O= outcome). Exclusion criteria: (1) Non English language articles published before year 2000 including (2) paediatric population and (3) evaluating sedation practices that do not include DSI. Inclusion criteria: (1) English language articles dating year 2000 and onwards, evaluating (2) DSI efficacy in (3) mechanically ventilated critically ill adult patients. Method: An extensive research evaluating DSI efficacy was carried out integrating literature recommendations and opinions from expertise in the local setting. The articles' methodological rigor was appraised using the Critical Appraisal Skill Programme, CASP (2010) and the Scottish Intercollegiate Guidelines Network, SIGN (2011). Results and conclusions: The literature appraised still remains uncertain about DSI efficacy however it cannot exclude that such intervention added to nurse-led sedation algorithms might result beneficial. Implications and recommendations: This project has highlighted the need to conducted larger double-blinded randomized controlled trials and an audit in the local intensive care setting in order to evaluate the feasibility of nurse-led sedation protocols including sedation vacations.