Mortality did not differ significantly between patients assigned to no sedation and patients assigned to light sedation with daily interruption in the intensive care unit (ICU), according to the results of a multicenter, randomized controlled study (NONSEDA; ClinicalTrials.gov Identifier: NCT01967680) published in the New England Journal of Medicine.1

Previous studies have demonstrated that daily interruption of sedation reduces the time on mechanical ventilation and the length of stay in the ICU in patients who are critically ill.2,3 However, data are lacking on whether a plan of no sedation compared with a plan of light sedation affects mortality.1 Therefore, researchers sought to investigate whether a plan of no sedation in 710 patients receiving mechanical ventilation would result in a better survival outcome than a plan of light sedation with daily interruption.

At baseline, the characteristics of the patients were similar in the 2 groups, except for the score on the Acute Physiology and Chronic Health Evaluation (APACHE) II, which was 1 point higher in the nonsedation group than in the sedation group, indicating a higher chance of in-hospital death.

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The mortality rate at 90 days was not significantly different between the nonsedation and sedation groups (42.4% vs 37.0%, respectively; P =.65). In addition, time on mechanical ventilation, length of ICU stay, and length of hospital stay did not differ significantly between the groups. The number of days free from coma or delirium was 1 day more in the nonsedation group than in the sedation group, and there were fewer thromboembolic events in the nonsedation group than in the sedation group.


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The authors concluded that, “The plan of no sedation resulted in no important differences in the number of ventilator free-days or in the length of ICU or hospital stay.”1

References

1. Olsen HT, Nedergaard HK, Strom T, et al. Nonsedation or light sedation in critically ill, mechanically ventilated patients [published online February 16, 2020]. N Engl J Med. doi:10.1056/NEJMoa1906759

2. Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342(20):1471-1477.

3. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilator patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. Lancet. 2008;371(9604):126-134.