CHEST Guidelines-Point--Should-All-ICU-Patients-Receive-Continuous-

Point--Should-All-ICU-Patients-Receive-Continuous-

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The debate about whether all ICU patients should receive continuous sedation revolves around differing strategies for managing sedation in mechanically ventilated patients. Continuous sedation is argued to provide constant drug levels, enhancing patient comfort and easing the workload of nursing staff. However, it may lead to over-sedation, increased drug use, and longer ICU stays, as highlighted in studies like Kollef et al. Conversely, intermittent sedation can potentially use less medication, which may avoid over-sedation but might diminish patient comfort and increase nursing demands.<br /><br />Continuous sedation often involves a daily interruption strategy, which has documented benefits, including reduced ventilator times and ICU stays, as well as fewer complications such as ventilator-associated pneumonia and catheter-related bloodstream infections. Kress et al. demonstrated that continuous sedation with daily breaks does not significantly increase the risk of myocardial ischemia, and studies by Schweickert et al. support reductions in ICU-related complications.<br /><br />Intermittent sedation strategies, which commonly rely on benzodiazepines like lorazepam, are less well-supported by head-to-head comparative studies. There's a mention of lorazepam being an independent risk for delirium in ICU patients. Continuous sedation using propofol or dexmedetomidine, as opposed to benzodiazepines, is recommended due to their lower accumulation risk.<br /><br />Both strategies have merits and limitations, but a key advantage of continuous sedation with daily interruption includes favorable psychological outcomes and better overall patient recovery, according to findings discussed by John Kress, MD. His summary suggests the optimal sedation strategy involves continuous infusion with a daily pause, pointing to its comprehensive benefits in ICU settings. <br /><br />In essence, while the evidence leans towards continuous sedation with daily breaks for its extensive benefits, further direct comparative studies are necessary for definitive conclusions.

Keywords

ICU sedation

continuous sedation

intermittent sedation

mechanically ventilated patients

daily interruption strategy

Kollef et al.

Kress et al.

Schweickert et al.

propofol

dexmedetomidine