Using daily "sedation vacations" and assessing the patient’s readiness to extubate is an integral part of the Ventilator Bundle and has been correlated with reduction in the rate of ventilator-acquired pneumonia.
Kress et al. conducted a randomized controlled trial in 128 adult patients on mechanical ventilation, randomized to daily interruption of sedation irrespective of clinical state or interruption at the clinician’s discretion. Daily interruption resulted in a marked and highly significant reduction in time on mechanical ventilation. The duration of mechanical ventilation decreased from 7.3 days to 4.9 days (p=0.004). [1]
It appears that lightening sedation decreases the amount of time spent on mechanical ventilation and therefore the risk of ventilator-acquired pneumonia. In addition, weaning patients from ventilators becomes easier when patients are able to assist themselves at extubation with coughing and control of secretions.
Sedation vacations are not without risks, however. Patients who are not sedated as deeply will have an increased potential for self-extubation. Therefore, the maneuver must be conducted in a careful fashion. In addition, there may be an increased potential for pain and anxiety associated with lightening sedation. Lastly, increased tone and poor synchrony with the ventilator during the maneuver may risk episodes of desaturation.
References:
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Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. New England Journal of Medicine. May 18 2000;342(20):1471-1477.
