Daily interruption of sedation in patients treated with mechanical ventilation

The evidence evaluating daily interruption of sedation (DIS) in mechanically ventilated patients, the benefits of this intervention, and the barriers to its incorporation into clinical practice are reviewed.

Recent epidemiologic studies have identified a high prevalence of oversedation in the intensive care unit (ICU). The practice of DIS, which involves withholding all sedative and analgesic medications until patients are awake on a daily basis, can limit excessive sedation. DIS has been shown to reduce the duration of mechanical ventilation and length of ICU stay, lessen the number of neurodiagnostic tests to assess for changes in mental status, decrease the frequency of complications associated with critical illness, and reduce the total dose of benzodiazepines and opiates administered. Although recent studies support the use of DIS, it remains underutilized in clinical practice and additional trials may be needed before this intervention will gain widespread acceptance. Barriers to the use of DIS include a lack of nursing acceptance and concerns regarding patient removal of invasive devices, patient discomfort, respiratory compromise, and withdrawal syndromes. Some clinicians are also concerned about the possibility of long-term psychological sequelae and the risk of myocardial ischemia during DIS in patients with coronary risk factors.

DIS limits oversedation in the ICU without compromising patient comfort or safety and should be incorporated into the routine care of mechanically ventilated patients. Clinicians should be aware of the numerous barriers that prevent the use of DIS and address these at their institution to increase its use.