The impact of daily sedation interruption versus total continuous sedation on length of mechanical ventilation and intensive care unit stay

Mechanically ventilated patients are at an increased risk for developing multiple ventilator-associated events (VAE). When patients are mechanically ventilated, many of the body’s defense mechanisms designed to filter and prevent pathogens from entering the airway, such as coughing, are rendered futile. This could result in potentially fatal complications such as ventilator-associated pneumonia (VAP), infection, and respiratory failure. These are adverse effects of prolonged, excessive, and continuous use of sedative medications during the process of using the ventilator. Consequently, the longer the patient is under sedation and mechanically ventilated, the higher the risk of developing associated complications and longer hospital stay. Total continuous sedation is the most common standard used in intensive care units (ICU) for mechanically ventilated patients to promote ventilator compliance and prevent agitation. However, the introduction of a daily sedation interruption protocol could ultimately shorten the amount of time a patient is intubated and sedated, thus resulting in lowering the risks of complications. This raises the question: In mechanically ventilated patients, how does daily sedation interruption compared to total continuous sedation affect the duration of mechanical ventilation and intensive care unit length of stay? A comprehensive integrative literature review was conducted in which the current studies were analyzed. The synthesis of findings from the studies was used to provide recommendations regarding daily sedation interruption. There clearly is a substantial benefit to daily sedation interruption when compared to continuous sedation infusion for qualified patients. There is a reduction in the risk of ventilator-associated events and the duration of ICU stay is lessened