MedWire News: A policy of no sedation for critically ill patients requiring mechanical ventilation may help to reduce their dependency on the ventilator, say Danish researchers.

“Results from this single-center study suggest that a strategy of no sedation is promising, but a multicenter trial is needed to show that the benefits of this strategy can be reproduced in other facilities,” they write in The Lancet.

Recently, daily interruption of sedation as opposed to continuous sedation has been shown to improve various patient outcomes. But continuous sedation is still in widespread use, say Thomas Strøm (Odense University Hospital) and colleagues.

In contrast, Odense University Hospital has followed a policy of no sedation, where possible, since 1999. Strøm and team assessed 428 critically patients, identified 140 who had no strong indications for sedation, and randomly assigned them to receive no sedation or to undergo sedation with daily interruption. Both groups received morphine.

During 28 days from inclusion, patients receiving no sedation spent an average of 13.8 days without ventilation, compared with 9.6 days for patients with interrupted sedation.

Patients receiving no sedation also spent significantly fewer days than those receiving interrupted sedation in intensive care, at 13.1 versus 22.8 days, and in hospital, at 34 versus 59 days. This remained significant after accounting for baseline variables.

Patients in the no sedation group had a slight but nonsignificant reduction in mortality relative to those in the interrupted sedation group. Complications including accidental removal of endotracheal tube, need for brain scans, and ventilator-associated pneumonia did not differ according to sedation policy. But 20% of no sedation patients suffered delirium, compared with 7% of interrupted sedation patients, a significant difference.

In a related editorial, Laurent Brochard (Centre Hospitalier Albert Chenevier–Henri Mondor, Créteil, France) said: “The protocol of no sedation seems to be associated with a need for more frequent individual assessment of the patient's pain, fear, anxiety, agitation, or confusion, and adaption to the ventilator.”

“Moreover, early and frequent mobilization of patients could have contributed to improved outcome, but such a strategy might have increased the workload for personnel.”

But he concluded: “The overall results, however, are impressive and promising. Use of this strategy will mean that more attention needs to be paid in the daily care of patients, and caregivers will need increased empathy towards patients. Hopefully, these findings will prove beneficial to patients.”