Kress / Daily Sedation Holidays (2000)

Continuous intravenous sedation in mechanically ventilated patients can lead to prolonged ventilation, increased ICU length of stay, and higher rates of complications. This study aimed to determine if daily interruption of sedative infusions could improve patient outcomes by reducing sedation duration and facilitating earlier extubation.

This was a prospective, randomized controlled trial conducted in a medical ICU, involving 128 mechanically ventilated adult patients receiving continuous intravenous sedation. Patients were randomized to either daily interruption of sedation until awakening or continuation of usual care, with the primary endpoint being the duration of mechanical ventilation.

Patients in the daily sedation interruption group had significantly fewer days of mechanical ventilation (4.9 vs. 7.3 days, p=0.004) and a shorter ICU length of stay (6.4 vs. 9.9 days, p=0.008). They also had a lower incidence of tracheostomy (12% vs. 24%, p=0.04) and no increase in adverse events such as self-extubation or ICU-acquired psychological trauma. The daily sedation interruption group also had a trend towards lower 28-day mortality (18% vs. 27%, p=0.22).

Daily interruption of continuous intravenous sedation in mechanically ventilated patients significantly reduces the duration of mechanical ventilation and ICU length of stay without increasing adverse events, and should be a standard practice.

The study was single-center and relatively small, potentially limiting generalizability. The control group received usual care without specific sedation targets, which might have contributed to higher sedation levels.