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Communications to the Editor |

Continuous IV Sedation and Prolonged Mechanical Ventilation FREE TO VIEW

Tacla A. Sfeir, MD; Tihomir Stefanec, MD
Author and Funding Information

Fellows Critical Care Medicine Saint Vincents Hospital and Medical Center New York, NY



Chest. 1999;115(2):604. doi:10.1378/chest.115.2.604-a
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To the Editor:

In the article published in the August 1998 issue of CHEST, Kollef and colleagues1 came to the conclusion that continuous IV sedation is associated with prolongation of mechanical ventilation. We do not agree with that conclusion.

As can be seen from the baseline characteristics of the study groups (Table 1 of their article),1 the continuous IV sedation group had significantly more patients with acute lung injury or ARDS, and their Pao2/Fio2 was significantly lower than the noncontinuous sedation group. The authors do not present data on the total amount of sedatives given in each group, but they show that (Table 2 of their article),1 despite receiving continuous IV sedation (72.1% are on lorazepam), the continuous group received additional IV bolus sedation in significantly higher percentage, and in the form of a relatively longer-acting sedative (lorazepam). In their linear regression model, the authors do not control for the degree of lung injury nor for the amount of the long-acting sedative that was administered; both factors affect the duration of mechanical ventilation.

We conclude that the observed differences in the duration of mechanical ventilation may be entirely related to the fact that the continuous IV sedation group had worse lung injury and received more long-acting sedatives than the bolus IV sedation groups and may have nothing to do with the way sedatives were administered.

Correspondence to: Tacla A. Sfeir, MD, New York Medical College, St. Vincents Hospital and Medical Center, Coleman 1050 East, 153 West 11th Street, New York, NY 10011

References

Kollef, MH, Levy, NT, Ahrens, TS, et al (1998) The use of continuous IV sedation is associated with prolongation of mechanical ventilation.Chest114,541-548
 

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References

Kollef, MH, Levy, NT, Ahrens, TS, et al (1998) The use of continuous IV sedation is associated with prolongation of mechanical ventilation.Chest114,541-548
 
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