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Nonsedation or light sedation in critically ill, mechanically ventilated patients

New England Journal of Medicine Feb 20, 2020

Olsen HT, Nedergaard HK, Strøm T, et al. - A multicenter, randomized, controlled trial was designed to evaluate the utility and safety of nonsedation or light sedation in critically ill, mechanically ventilated individuals. A sum of 710 individuals underwent randomization, and 700 were recruited in the modified intention-to-treat analysis. Researchers randomly allocated, in a 1:1 ratio, mechanically ventilated ICU patients to a plan of no sedation (nonsedation group) or to a plan of light sedation (i.e., to a level at which the patient was arousable, defined as a score of −2 to −3 on the Richmond Agitation and Sedation Scale [RASS], on which scores range from −5 [unresponsive] to +4 [combative]) (sedation group) with daily interruption. The mortality at 90 days was considered a primary endpoint. Secondary endpoints included the number of major thromboembolic events, the number of days free from coma or delirium, acute kidney injury according to severity, the number of ICU-free days, and the number of ventilator-free days. Between-group differences were estimated as the value in the nonsedation group minus the value in the sedation group. The mortality at 90 days did not differ significantly between those assigned to a plan of no sedation and those assigned to a plan of light sedation with daily interruption among mechanically ventilated ICU individuals.
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