A critical review of daily sedation interruption in the intensive care unit

Authors

  • Mark O’Connor,

    1. Authors:Mark O’Connor, RN, DipN, BSc (Hons), Crit Care Cert, Clinical Nurse Specialist, Alfred Hospital Intensive Care Unit, Masters of Nursing (Research) Candidate, School of Nursing, The University of Melbourne, Carlton, Victoria, Australia; Tracey Bucknall, PhD, RN, Professor of Nursing, Deakin University Head, Cabrini/Deakin Centre for Nursing Research, Burwood, Victoria, Australia; Elizabeth Manias, PhD, RN, Cert Crit Care, MNStud, FRCNA, Associate Professor, Associate Head of Research Training, School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
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  • Tracey Bucknall,

    1. Authors:Mark O’Connor, RN, DipN, BSc (Hons), Crit Care Cert, Clinical Nurse Specialist, Alfred Hospital Intensive Care Unit, Masters of Nursing (Research) Candidate, School of Nursing, The University of Melbourne, Carlton, Victoria, Australia; Tracey Bucknall, PhD, RN, Professor of Nursing, Deakin University Head, Cabrini/Deakin Centre for Nursing Research, Burwood, Victoria, Australia; Elizabeth Manias, PhD, RN, Cert Crit Care, MNStud, FRCNA, Associate Professor, Associate Head of Research Training, School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
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  • Elizabeth Manias

    1. Authors:Mark O’Connor, RN, DipN, BSc (Hons), Crit Care Cert, Clinical Nurse Specialist, Alfred Hospital Intensive Care Unit, Masters of Nursing (Research) Candidate, School of Nursing, The University of Melbourne, Carlton, Victoria, Australia; Tracey Bucknall, PhD, RN, Professor of Nursing, Deakin University Head, Cabrini/Deakin Centre for Nursing Research, Burwood, Victoria, Australia; Elizabeth Manias, PhD, RN, Cert Crit Care, MNStud, FRCNA, Associate Professor, Associate Head of Research Training, School of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia
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Mark O’Connor, Clinical Nurse Specialist, Alfred Hospital Intensive Care Unit, Masters of Nursing (Research) Candidate, School of Nursing, The University of Melbourne, Carlton, Victoria 3053, Australia. Telephone: +61 3 8344 0800.
E-mail:mar1oconnor2@yahoo.com.au

Abstract

Background.  Daily sedation interruption (DSI) has been proposed as a method of improving sedation management of critically ill patients by reducing the adverse effects of continuous sedation infusions.

Aim.  To critique the research regarding daily sedation interruption, to inform education, research and practice in this area of intensive care practice.

Design.  Literature review.

Method.  Medline, CINAHL and Web of Science were searched for relevant key terms. Eight research-based studies, published in the English language between 1995–December 2006 and three conference abstracts were retrieved.

Results.  Of the eight articles and three conference abstracts reviewed, five originated from one intensive care unit (ICU) in the USA. The research indicates that DSI reduces ventilation time, length of stay in ICU, complications of critical illness, incidence of post-traumatic stress disorder and is reportedly used by 15–62% of ICU clinicians in Australia, Europe, USA and Canada.

Conclusions.  DSI improves patients’ physiological and psychological outcomes when compared with routine sedation management. However, research relating to these findings has methodological limitations, such as the use of homogenous samples, single-centre trials and retrospective design, thus limiting their generalisability.

Relevance to clinical practice.  DSI may provide clinicians with a simple, cost-effective method of reducing some adverse effects of sedation on ICU patients. However, the evidence supporting DSI is limited and cannot be generalised to heterogeneous ICU populations internationally. More robust research is required to assess the potential impact of DSI on the physical and mental health of ICU survivors.

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