Multimodal, patient-centred symptom control: a strategy to replace sedation in the ICU

Worldwide, more than 20 million patients annually receive mechanical ventilation in an intensive care unit (ICU). 1 Adhikari NKJ Fowler RA Bhagwanjee S Rubenfeld GD Critical care and the global burden of critical illness in adults. Lancet. 2010; 376: 1339-1346 Summary Full Text Full Text PDF PubMed Scopus (766) Google Scholar Infusions of sedating medications (eg, benzodiazepines, dexmedetomidine, opioids, or propofol) or volatile anaesthetics (eg, isoflurane) are commonly used in mechanically ventilated patients in high-income countries and their use increased during the COVID-19 pandemic. 2 Wongtangman K Santer P Wachtendorf LJ et al. Association of sedation, coma, and in-hospital mortality in mechanically ventilated patients with coronavirus disease 2019-related acute respiratory distress syndrome: a retrospective cohort study. Crit Care Med. 2021; 49: 1524-1534 Crossref PubMed Scopus (27) Google Scholar Sedation—defined as the administration of a sedating medication to impair consciousness—is a common practice in the ICU due to traditions of clinical teaching and other reasons that are not evidence-based and not necessarily patient-centred. 2 Wongtangman K Santer P Wachtendorf LJ et al. Association of sedation, coma, and in-hospital mortality in mechanically ventilated patients with coronavirus disease 2019-related acute respiratory distress syndrome: a retrospective cohort study. Crit Care Med. 2021; 49: 1524-1534 Crossref PubMed Scopus (27) Google Scholar , 3 Devlin JW Skrobik Y Gélinas C et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the intensive care unit. Crit Care Med. 2018; 46: e825-e873 Crossref PubMed Google Scholar , 4 Chanques G Conseil M Roger C et al. Immediate interruption of sedation compared with usual sedation care in critically ill postoperative patients (SOS-Ventilation): a randomised, parallel-group clinical trial. Lancet Respir Med. 2017; 5: 795-805 Summary Full Text Full Text PDF PubMed Scopus (49) Google Scholar