Table 1

Criteria used in studies to separate ‘deeper’ versus ‘lighter’ sedation*

StudyControl/‘Deeper’ sedationIntervention/‘Lighter’ sedation
Balzer et al17Patients had >85% RASS scores ≤−3
First RASS −5 (−5 to −4)
Time to reach first RASS >−3: 79 (52−141) hours		First RASS: −4 (−5 to −1), p<0.001
Time to reach first RASS >−3: 11 (5–20) hours, p=0.001
Bugedo et al18Midazolam: 0.03 (0.01–0.06) mg/kg/hour
Fentanyl: 0.6 (0.1–1.4) μg/kg/hour
Proportion: SAS 1–2: 55%; SAS 3–4: 37%		Midazolam: 0.01 (0–0.03) mg/kg/hour, p<0.001
Fentanyl: 1.5 (0.8–2.4) μg/kg/hour, p<0.001
Proportion: SAS 1–2: 44%; SAS 3–4: 49%, p=0.001
Burry et al41Midazolam: 97.0±200.8 mg/patient/day
Fentanyl: 1.9±3.5 mg/patient/day		Midazolam: 64.7±245.8 mg/patient/day, p<0.0001
Fentanyl: 1.1±2.0 mg/patient/day, p<0.0001
Dale et al19Hourly benzodiazepine dose: 0.23±0.018 mg
Total benzodiazepine dose: 49.2±156.5 mg
24 hours weighted average RASS: −1.30±0.026		Hourly benzodiazepine dose: 0.15±0.011 mg, p<0.01
Total benzodiazepine dose: 17.2±53.6, p<0.01
24 hours weighted average RASS: −0.99±0.023, p<0.01
Faust et al20RASS (median): −2.57 ((−3.23 to −1.40)
% RASS scores −3 to −5 in first 24 hours: 46.8%±46.9%		RASS (median): −1.25 (−2.3 to −0.40), p=0.001
% RASS scores −3 to −5 in first 24 hours: 27.3%±37.3%, p=0.006
Guttormson21Classed as ‘minimally arousable’ based on Sedation Intensity ScoreClassed as ‘easily arousable’ based on Sedation Intensity Score
Khan et al22RASS scores—weekdays: median—4
RASS scores—weekends: median—5		RASS—weekdays: increased by 0.88, p<0.0001
RASS—weekends: increased by 1.20, p<0.0001
Mehta et al23 †Midazolam: 102±326 mg/patient/day
Fentanyl: 1780±4135 µg/patient/day		Midazolam: 102±326 mg/patient/day, p=0.04
Fentanyl: 1070±2066 µg/patient/day, p<0.001
Nassar Junior, Park M24SAS scores: 3.2 (2.6–3.7)
Midazolam: 45 (0.201) mg
Fentanyl: 1500 (520–4215) mg		SAS scores: 3.6 (3.4–4.0), p=0.035
Midazolam: 0 (0.0–0.05) mg, p<0.001
Fentanyl: 300 (100–1520) mg, p=0.004
Olsen et al25Midazolam mg/kg/hour (day 2–28): 0.000187 (0–0.003410)
Propofol mg/kg/hour (day 1–2): 0.84 (0.29–1.2); (day 3–28): 0.0064 (0–0.034)
Mean RASS: day 1: −2.3; day 7: −1.8		Midazolam mg/kg/hour (day 2–28): 0 (0–0.000005); NS
Propofol mg/kg/hour (day 1–2): 0.22 (0–0.054); difference: −0.62 (−0.72; −0.53); (day 3–28): 0 (0–0.013); difference: −0.0063 (−0.874; −0.0037)
Mean RASS: day 1: −1.3; day 7: −0.8
Quenot et al26Midazolam: 92±59 mg/patient/day
Propofol: 2900±1400 mg/patient/day		Midazolam: 44±31 mg/patient/day, p=0.001
Propofol: 1840±750 mg/patient/day, p=0.01
Ren et al31Sufentanil: 0.030±0.007 mg/kg/hour
Midazolam: 0.029±0.007 mg/kg/hour		Sufentanil: 0.018±0.009 mg/kg/hour, p<0.0001
Midazolam: 0.017±0.009 mg/kg/hour, p<0.0001
Samuelson et al27Target MAAS: 1–2
Actual MAAS: median 1.25 (1.0)		Target MAAS: 3–4
Actual MAAS: median 3.0 (0.0)
Sen et al32Total benzodiazepine dose: 450±701 mgTotal benzodiazepine dose: 74±159 mg, p<0.01
Shehabi et al28Dexmedetomidine: 20.58 (20.58–20.58) µg
Midazolam: 0.3 (0.23–0.76) mg
Propofol: 33.55 (13.54–77.07) mg
RASS assessments −2 to +1: 38%		Dexmedetomidine: 36.55 (16.38–13.23) µg, p<0.0001
Midazolam: 0.06 (0.02–1) mg, p=0.036
Propofol: 9.89 (2.41–22.51) mg, p=0.046
RASS assessments −2 to +1: 66%, p=0.01
Shehabi et al33RASS −3 to −5 at 48 hoursRASS lighter than −3 to −5 at 48 hours
Strøm et al42Propofol: 1.40 (0.52–2.04) mg/kg/hour
Midazolam: 0.01 (0–0.04) mg/kg/hour		Propofol: 0 (0–1.26) mg/kg/hour, p=0.013
Midazolam: 0 (0–0) mg/kg/hour, p=0.003
Strøm et al29Propofol: 0.77 (0.15–1.65) mg/kg/hour
Midazolam: 0.003 (0–0.024) mg/kg/hour		Propofol: 0 (0–0.52) mg/kg/hour, p=0.0001
Midazolam: 0 (0–0) mg/kg/hour, p<0.0001
Treggiari et al30Target Ramsay sedation score 3–4
Daily median Ramsay range: 3 (2–4.5) to 4 (3–5)
Daily midazolam range: 24.2±45.1 to 95.3±124.5 mg		Target Ramsay sedation score 1–2
Daily median Ramsay range: 1 (1–2) to 3 (1–3)
Daily midazolam range: 3.0±5.0 to 11.7±23.2 mg

  • *It was not possible to create two categories of ‘deeper’ or ‘lighter’ sedation in seven studies.34–39

  • †‘Deeper’ sedation group was the intervention (daily interruption of sedation) group.

  • MAAS, Motor Activity Assessment Scale; RASS, Richmond Agitation Sedation Scale; SAS, Riker Sedation Agitation Scale.