Disadvantages of sedation in intensive care include prolonged ventilation, delirium and difficulties in mental status assessment. Previous studies comparing bolus sedation with continuous sedation have demonstrated a reduced duration of mechanical ventilation with boluses.

In this study 140 critically ill patients undergoing mechanical ventilation were randomised in a 1:1 ratio to receive no sedation or standardised sedation with propofol/midazolam and daily awakening. The groups were similar phenotypically. Both groups were treated with bolus dose morphine for comfort. Patients receiving no sedation had more ventilator-free days (mean difference 4.2 days). The same patients also had shorter stays in intensive care (HR 1.86). There was no significant difference in mortality between groups in the occurrence of complications or need for tracheostomy. However, incidents of delirium were higher in the no sedation group (20% vs 7%), as was the use of haloperidol. 18% of patients in the no sedation group did not tolerate the intervention.

This single-centre study concludes that sedation-free ventilation is associated with shorter periods of ventilation with no increase in short-term complications. It remains to be seen if the incidence of post-traumatic stress disorder syndrome is higher in these patients. The authors plan a 1 year review.

▶ Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 2010;375:475–80.