Is Daily Awakening Always Safe in Severely Brain Injured Patients?

Excerpt

Sedation is a central component of critical care to prevent sleep deprivation, pain, anxiety, agitation, and delirium. Daily interruption of sedation (DIS) decreases the duration of mechanical ventilation, shortens hospital stay and may, in combination with spontaneous breathing trials, improve outcome in medical intensive care patients [1, 2]. Moreover, the amount of sedatives and opioids administered, which is directly associated with morbidity (nosocomial infections and thromboembolic events), can be reduced by DIS [1, 2]. Therefore, sedative drugs should be titrated to a lower level when sedation is restarted, which is, in our mind, the major factor contributing to decrease ventilation and ICU days. An estimated 30–40% of intensive care units worldwide have implemented daily interruption of sedation as a routine protocol [3‐5]. Even if daily interruption of sedation could be a cornerstone for medical intensive care patients, it has not extensively been studied so far in acutely brain injured patients. So, can these results be translated to patients with subarachnoidal hemorrhage (SAH), intracerebral hemorrhage (ICH), or traumatic brain injury (TBI)? In fact, in a recent randomized control trial, the subgroup of acutely head injured patients did not show decreased ventilation or ICU days when sedation was interrupted on a daily basis (n = 21) compared to controls (n = 17) [6]. …