Implementing sedation protocols: closing the evidence-practice gap - Critical Care Science (CCS)

Implementing sedation protocols: closing the evidence-practice gap |

Sedation and analgesia are frequently used in the critical care unit. Pain has already been described as the "fifth vital sign," and most people describe experiencing pain as a source of great stress during an intensive care unit (ICU) stay.^{( , )} Sedation can be used to ease discomfort, to facilitate adaptation to mechanical ventilation, and to prevent self-harm.^{( )} However, despite its humanitarian intentions, over-sedation is associated with prolonged mechanical ventilation, increased delirium rates, longer ICU lengths of stay (LOS), and increased mortality.^{( , )}

In recent decades, many studies have addressed the risks of over-sedation.^{( )} Kress et al. were the first to demonstrate that a protocol of daily awakening led to a reduced duration of mechanical ventilation and of ICU LOS.^{( )} Subsequently, Girard et al. performed a trial comparing daily awakening plus spontaneous breathing trials with standard sedation practices plus spontaneous breathing trials and showed that the intervention group had an improved 1-year mortality, with an impressive NNT of 7.^{( )} More recently, a "no-sedation, analgesia-based" trial also showed more ventilator-free days and reduced ICU and hospital LOS.^{( )}

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