Abstract
Traditionally, critically ill patients undergoing mechanical ventilation (MV) have
received sedation. Over the last decade, randomized controlled trials have questioned
continued use of deep sedation. Evidence shows that a nurse-driven sedation protocol
reduces length of MV compared with standard strategy with sedation. Furthermore, daily
interruption of sedation reduces length of MV, intensive care unit (ICU), and hospital
length of stay (LOS). A larger scale trial with daily interruption of sedation has
confirmed these findings and furthermore showed a reduction in 1-year mortality with
the use of daily interruption of sedation. Recently, a strategy with no sedation has
been described reporting a reduction in length of MV, ICU, and hospital LOS compared
with a strategy with daily interruption of sedation. Follow-up trials report that
reducing sedation does not seem to increase the risk of psychological morbidity. Moreover,
delirium has gained increased focus in recent years with development of validated
tools to detect both hyperactive and hypoactive forms of delirium. Using validated
tools for detecting delirium is important in monitoring and detecting acute brain
dysfunction in critically ill patients. Evidence from randomized trials also cites
a beneficial effect of early mobilization with respect to length of MV and delirium.
Keywords
analgesics - critical illness - hypnotics and sedatives - intensive care - length
of stay - delirium - mechanical ventilation
