Daily sedation interruption versus no daily sedation interruption for critically ill adults and children requiring invasive mechanical ventilation.
Louise Rose, David R Williamson, Iain J McCullagh et al.
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In 30 seconds
This updated Cochrane systematic review and meta-analysis assessed daily sedation interruption (DSI) versus sedation strategies without interruption in critically ill adults and children receiving invasive mechanical ventilation. It included 23 randomised trials with 5987 participants (4910 adjusted). DSI may modestly shorten ventilation, while probably reducing mortality and ICU length of stay. For mortality, the pooled relative risk was 0.88 (95% CI 0.77 to 0.99; 18 studies, 4057 participants), with moderate-certainty evidence. Evidence for shorter ventilation was low certainty, and results varied substantially across studies.
Key findings
- DSI may reduce ventilation duration by 14% (95% CI 1% to 25%); evidence was low certainty.
- Mortality was probably lower with DSI (RR 0.88, 95% CI 0.77 to 0.99; 18 studies, 4057 participants).
- DSI probably reduced ICU length of stay by 11% (95% CI 2% to 20%; 18 studies, 4477 participants).
- Self or accidental endotracheal tube removal may differ little between strategies (RR 0.88, 95% CI 0.66 to 1.19; one study).
Why it matters
Sedation interruption is intended to limit sedative accumulation and support a more awake state during ventilation. This review suggests it may improve several important outcomes, including mortality and time in intensive care, while the estimated ventilation benefit is less certain. The findings help frame DSI as one sedation-management strategy, with evidence strength differing by outcome and substantial variation in ventilation-duration results.
What to keep in mind
Evidence certainty varied by outcome: ventilation-duration evidence was low certainty, and heterogeneity was high (I² = 88%). The review combined adult and paediatric trials and several different comparator sedation strategies.