CHEST Guidelines-Counterpoint--Should-All-ICU-Patients-Receive-Cont

Counterpoint--Should-All-ICU-Patients-Receive-Cont

Pdf Summary

The editorial discusses the use of continuous sedation in ICU patients, particularly those on mechanical ventilation, and presents arguments against its widespread application. Historically, sedation has been used to ease patient discomfort and aid ventilation; however, over-sedation is linked with various complications like prolonged mechanical ventilation and delirium. Notably, continuous sedation has been shown to double in use from 2001 to 2007, even after adjusting for severity of illness.<br /><br />The piece highlights that continuous sedation can lead to what Dr. Thomas Petty described as a “suspended life,” where patients appeared lifeless. Studies indicate that limiting sedation can yield beneficial outcomes. Research by Dr. Kress and others showed that daily interruptions in sedation reduced ICU stay duration and ventilator dependence, appearing safe regarding myocardial and neuropsychiatric outcomes.<br /><br />Further studies revealed that coupling these sedation breaks with spontaneous breathing trials can increase ventilator-free days and improve survival rates. Notably, during a propofol shortage, hospitals using minimal sedation reported no adverse changes in ventilation outcomes, and subsequent studies suggested that even a “no sedation” protocol can lead to fewer days on ventilation and better overall health outcomes.<br /><br />The editorial supports a nuanced approach, integrating factors like analgesia, delirium monitoring, and early mobilization with limited sedation. The “ABCDE” mnemonic is proposed to guide ICU practices: Awakening, Breathing, Choice of Sedation and analgesia, Delirium monitoring, and Early mobilization.<br /><br />In conclusion, the piece argues against the assumption that all ICU patients require continuous sedation, advocating for protocols that identify patients who do not need extensive sedation, thereby improving recovery and outcomes.

Keywords

continuous sedation

ICU patients

mechanical ventilation

over-sedation complications

sedation breaks

spontaneous breathing trials

no sedation protocol

analgesia

delirium monitoring

early mobilization