Immediate interruption of sedation for post-operative patients in the ICU reduces time on mechanical ventilation

Traditionally intensive care patients undergoing invasive mechanical ventilation have been sedated. In the last two decades increasing focus has been on reducing sedation for critically ill patients. Brook and colleagues reported a reduction in length of stay by implementing a nurse drive sedation protocol (1). This trial was very simple just giving the nurses the possibility to adjust the sedation to the patients need without having to contact a doctor. Also the trial made bolus doses possible instead of continuous infusion. Kress and colleagues reported reduced time on mechanical ventilation by performing a daily interruption of sedation (2). The intervention group was kept sedated to RAMSAY 3–4 and received a daily wake up trial. The sedation was afterwards stated on half the previous dose ensuring that patients were not over sedated. These finding was confirmed and further findings reported by Girard and colleagues in the ABC trial (3).