Patient-ventilator asynchrony during daily interruption of sedation versus no sedation protocol

Daily interruption of sedation could minimize the problem of sedatives accumulation. Nevertheless, whatever is the sedation strategy; sedation, particularly deep levels, has been associated with high frequency of patient-ventilator asynchrony. Extending these findings, one would expect that no sedation protocol could reduce the frequency of patient-ventilator asynchrony.

To assess the effect of no sedation protocol compared with daily interruption of sedation on patient-ventilator asynchrony in surgical intensive care patients.

The study included 230 patients who expected to require mechanical ventilation for more than 48 h. They were randomized to receive either continuous sedation (1 mg/mL midazolam) to achieve a Ramsay score of 3-4 with daily interruption until awake (group D; n = 115), or no sedation (group N; n = 115). Both groups received bolus doses of morphine (2.5-5 mg) as needed to achieve a score of ≤2 on behavioral pain scale.

No sedation was associated with significantly lower ineffective triggering and asynchrony index but significantly higher double triggering. Patient's effort during triggering was significantly higher during no sedation. The respiratory rate increased and the PaCO2 decreased significantly in no sedation group.

No sedation protocol reduces the asynchrony index and preserves the patient's effort during triggering.