Continuous sedation vs. daily sedation interruption in mechanically-ventilated children
Abstract: A daily sedation
interruption (DSI) protocol in ventilated patientsis an effective method of
improving sedation management that decreases the duration of mechanical ventilation.
In adult patients, it is a safe and effective approach, as well as common
practice. For ventilated children,its effectiveness and feasibilityare unknown.
Objective To compare continuous sedation and DSI in
mechanically-ventilated children with respect todurationof mechanical
ventilation, the time needed for patients to awaken, and the frequency of
adverse events.
Method This randomized, controlled, open-label trial, was performed in a
pediatric intensive care unit (PICU). Forty children on mechanical ventilation
were included. Patients were randomly assigned to receive either continuous
sedation or DSI. The duration of mechanical ventilation was the primary
outcome, while the time for patients to awaken on sedative infusion and the
frequency of adverse events were secondary outcomes.
Results Forty patients were randomized into the continuous sedation
protocol (18 subjects) or into the DSI protocol (22 subjects). The median
(interquartile range) duration of mechanical ventilation was significantly
shorter in the DSI compared to the continuous sedation group [41.50 (30-96)
hours vs. 61 (30-132) hours, respectively; (P=0.033)]. The time for patients to
awaken was also significantly lower in the DSI than in the continuous sedation
group [median (interquartile range): 28 (24-78) vs. 45.5 (25-12) hours,
respectively; (P=0.003)]. The frequencies of adverse events were similar in
both groups. The severity of illness contributed to outcome variables.
Conclusion The duration of mechanical ventilation and the time for
patients to awaken are significantly reduced in the DSI group compared to the
continuous sedation group.
Author: Henri Azis, Silvia
Triratna, Erial Bahar
Journal Code: jpkedokterangg160020
