Sedation during mechanical ventilation: a comparison of sedatonarcosis and awake sedation

Introduction

The most important goal during mechanical ventilation in the ICU is to achieve patient comfort and patient–ventilator synchrony. Once proper analgesia has been established, an infusion of a sedative should be added. The goal of this study was to investigate whether continuously awake sedation during mechanical ventilation (MV) decreased the days of ventilation and complications.

Methods

All patients with MV – based on the abovementioned criteria – were included (age: 20–70 years; community-acquired pneumonia; two quadrant infiltrates; PaO₂/FiO₂ < 200; no other organ dysfunction). From June 2001 to February 2004, patients with MV received deep sedation (midazolam 0.03–0.20 mg/kg body weight/hour and propofol 0.5–2.0 mg/kg body weight/hour). This is the 'sedatonarcosis' group. From March 2004 to July 2007, patients were treated with 'awake sedation' (alprasolam 1.5–2.0 mg/day).

Results

All of the patients received low tidal volume ventilation, de-escalation antibiotics, continuous correction of homeostasis, management of enteral feeding and pulmonary physiotherapy. In both groups we applied noninvasive respiratory therapy after extubation. It was possible to mobilise patients earlier – before the extubation – in the awake sedation group. See Table 1.

Table 1 Results

Conclusion

Adopting awake sedation during MV (compared with continuous sedatonarcosis) decreased the days on ventilation, and the lengths of ICU and hospital stay.