Benefits of Daily Sedation Holidays

Studies show that daily breaks from sedative infusions can decrease mortality and shorten hospital stays for mechanically ventilated patients.^1-3 Both lighter sedation and daily sedation holidays lower the risk of mortality and complications, such as drug-induced delirium or ventilator associated pneumonia.^1-6

Taking a break from sedation can also:

• Help prevent drug accumulation and oversedation³
• Allow your patient time to reorient and even reduce psychological trauma from critical care stresses⁷ 

Provide an important opportunity to assess your patient’s neurological and respiratory status,¹ as well readiness to be weaned from sedation and mechanical ventilation^3-6

Understand the Risk of Oversedation

Though some conditions do call for uninterrupted sedation, mechanical ventilation patients may need continuous sedation for as little as 20 percent of the time.⁸ Weigh the benefit for each of your patients against the risks — both obvious and subtle. Levels of continuously dosed medication can build up over time³ and sedation depth and adequacy can be difficult to judge, even with validated rating scales.⁹

In one study, caregivers rated patients as oversedated only 2.6 percent of the time. Yet researchers found the same patients minimally or nonarousable in 32 percent of their assessments and motionless in 21 percent.⁹ A second study concluded that continuous intravenous sedation may correspond with prolonged mechanical ventilation.¹⁰

Related: Can a ventilator filter choice help protect clinicians from contagious respiratory pathogens? See the lessons learned from two Canadian hospitals managing viral outbreaks.

Know When Patients Need a Break from Sedation

Before beginning a sedation holiday, assess whether your patient passes a safety screen for the break.^5,10 If yes, you'll most likely stop sedative infusion and allow the patient to wake fully.⁴ This is usually done each day.^4,11 The duration of the break depends on the patient, the sedative used, and your goals for the sedation holiday.^4,11

Monitor for signs of discomfort as your patient awakens. Generally, you will not restart sedation until after you’re sure the patient is alert and responsive and you have completed your assessment.^4,11 In spontaneous awakening trials and titration protocols, you’ll usually resume sedation only when the patient shows signs of agitation, anxiety, or respiratory distress.^4,5,11 In that case, restart sedation at a reduced rate or the lowest dose that provides adequate patient comfort.^4,5,11

Related: Learn about ventilation basics.

Help Reduce Complications

With daily sedation holidays, you and your patients may see fewer complications and quicker weaning from sedatives and mechanical ventilation.³ And using spontaneous breathing trials after sedation breaks may offer even more benefit.^2,4,5,11,12 

Related: Read more about spontaneous breathing trials.

If you don't already use a standardized program of sedation holidays and assessments, consider adding one to help ensure consistent care for your patients.^4,11

References:
1. Frontera JA. Delirium and sedation in the ICU. Neurocrit Care. 2011;14:463–474.
2. Roberts D J, Haroon B, Hall RI. Sedation for critically ill or injured adults in the intensive care unit: a shifting paradigm. Drugs. 2012;172(14):1881–1916.
3. 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.
4. Luetz A, Goldmann A, Weber-Carstens S, Spies C. Weaning from mechanical ventilation and sedation. Curr Opin Anaesthesiol. 2012;25(2):164–169.  
5. Hooper MH, Girard TD. Sedation and weaning from mechanical ventilation: linking spontaneous awakening trials and spontaneous breathing trials to improve patient outcomes. Anesthesiol Clin. 2011;29(4):651–661.
6. Brook AD, Ahrens TS, Schaiff R, et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med. 1999;27(12):2609–2615.
7. Kress JP, Gehlbach B, Lacy M, Pliskin N, Pohlman AS, Hall JB. The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med. 2003;168(12):1457–1461.
8. Salgado DR, Favory R, Goulart M, Brimioulle S, Vincent JL. Toward less sedation in the intensive care unit: a prospective observational study. J Crit Care. 2011;26(2):113–121.
9. Weinert CR, Calvin AD. Epidemiology of sedation and sedation adequacy for mechanically ventilated patients in a medical and surgical intensive care unit. Crit Care Med. 2007;35(2):393–401.
10. Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G. The use of continuous IV sedation is associated with prolongation of mechanical ventilation. Chest. 1998;114(2):541–548.
11. Dunn JG, Baker MW. Daily sedation breaks and breathing trials help wean patients from ventilators safely: the authors give advice on developing a nurse-implemented sedation protocol. Am Nurse Today. 2011;6(3).
12. Girard TD, Kress JP, Fuchs BD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008;371(9607):126-134.

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TOPIC: Mechanical Ventilation, Puritan Bennett™ Ventilators