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Maintaining light sedation is important: next steps for research
  1. John W Devlin1,2,
  2. Bhavna Seth3,
  3. Sarah Train1,
  4. Dale M Needham3,4
  1. 1 Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2 School of Pharmacy, Northeastern University, Boston, Massachusetts, USA
  3. 3 Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  4. 4 Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr John W Devlin, Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; j.devlin{at}northeastern.edu

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Critically ill adults are frequently administered continuous sedative and/or opioid infusions, based on clinicians’ intentions of optimising comfort, facilitating mechanical ventilation and promoting safety.1 Deep sedation, more prevalent during the current SARS-CoV-2 pandemic,2 is associated with coma, delirium and muscle weakness, with associated impairments in survival and physical, cognitive and mental health.1 The 2013 Pain, Agitation and Delirium (PAD) guidelines made an ungraded statement that using a sedation protocol (SP) to target light levels of sedation or instituting Spontaneous Awakening Trials (SAT) will improve short-term outcomes (eg, duration of mechanical ventilation or ICU stay).3 The 2018 PAD, Immobility and Sleep (PADIS) guidelines make a graded conditional recommendation that light (vs deep) sedation, should be used, regardless of sedative choice, in critically ill, mechanically ventilated adults.1

The PADIS panel relied on evidence from eight randomised controlled trials (RCTs), published prior to October 2015, where light versus deep sedation was defined a priori and evaluated ≥4 times daily.1 Studies solely evaluating an SAT were excluded as this approach often results in light sedation at only a single time point during the 24-hour day.1 Results from RCTs were prioritised over cohort studies. Four RCTs compared a light (vs deep) sedation approach using the same sedative regimen. The other four RCTs compared a light (vs deep) approach where the light group either received a no (or ‘as needed’) sedation approach (n=2) or dexmedetomidine (n=2). Two RCTs implemented light sedation intervention for …

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Footnotes

  • Twitter @devlinpharmd, @DrDaleNeedham

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JD is a consultant to Haisco-USA Pharmaceuticals and BioExcel Pharma (USA). He is also currently receiving research funding from BioExcel Pharma, the National Institute of Aging, and the Canadian Institute of Health Research. DMN is a consultant to Haisco-USA Pharmaceuticals, Novartis Pharma (Switzerland) and GlaxoSmithKline (UK). He also is a principal investigator on an NIH-funded, multicentred randomised trial (R01HL132887) evaluating nutrition and exercise in acute respiratory failure and, related to this trial, is currently in receipt of an unrestricted research grant and donated amino acid product from Baxter Healthcare Corporation and an equipment loan from Reck Medical Devices.

  • Provenance and peer review Commissioned; externally peer reviewed.

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