Evaluating the Impact of Daily Sedation Interruption on Mechanical Ventilation Duration in Critically Ill Patients

Abstract

Background: About 85% of critically ill patients require sedation during intensive care unit stay. However, excessive sedation can lead to adverse outcomes, including ventilator-associated pneumonia and prolonged mechanical ventilation and intensive care unit stays. One approach to reduce sedation could involve daily sedation interruption, which might improve clinical outcomes.

Aim: This dissertation aimed to conduct a structured literature review to assess the impact of daily sedation interruption, compared to no daily sedation interruption, on the duration of mechanical ventilation in critically ill adult patients.

Methods: A comprehensive structured literature review was carried out using four databases: MEDLINE (OVID), Embase (OVID), Cochrane Library and CINAHL (EBSCOhost). A comprehensive list of keywords and related terms and inclusion and exclusion criteria were developed as part of the literature search strategy.

Results: After applying automation tools to filter for age and language, 2,246 articles were identified. Based on the inclusion and exclusion criteria, seven randomised controlled trials involving a total of 1,201 patients were deemed eligible for this dissertation. Certain studies revealed a significant reduction in the primary outcome—the duration of mechanical ventilation—upon the implementation of daily sedation interruption. In contrast, other studies found no significant difference between the daily sedation interruption group and the no daily sedation interruption group. Similarly, the impact of daily sedation interruption on the secondary outcome—length of ICU stay—yielded contradictory results. Some trials reported shorter ICU stays, while others revealed no notable differences between the intervention and control groups.

Conclusion: There were conflicts in the findings of the selected RCTs. While some studies indicated that daily sedation interruption in critically ill patients resulted in positive and significant outcomes in mechanical ventilation and length of ICU stay, others did not find significant impact.