Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Washington University School of Medicine
Director, Medical Intensive Care Unit
Medical Director, Respiratory Therapy
St. Louis, MO
To the Editor:
Drs. Sfeir and Stefanec raises the point that we did not control
adequately for the degree of lung injury in our linear regression
model, which determined that the use of continuous IV sedation was
associated with prolongation of mechanical ventilation. I agree with
this conclusion. It is extremely difficult in a cohort study to prove
causality between a potential risk factor and the outcome of interest.
Such studies are primarily used to generate hypotheses or other
questions for future investigation. Because of the results we obtained
in this study, we subsequently performed a randomized controlled study
examining the influence of protocolized sedation for the management of
patients with acute respiratory failure. The main goal of this study
was to determine whether a systematic approach to the administration of
IV sedation to patients with acute respiratory failure requiring
mechanical ventilation resulted in beneficial outcomes, including a
reduction in the duration of mechanical ventilation. We have recently
completed this study and hope to present its results in the near
Correspondence to: Marin H. Kollef, MD, FCCP, Division of
Pulmonary and Critical Care Medicine, Washington University School of
Medicine, 660 South Euclid Avenue, Box 8052, St. Louis, MO 63110-1093;
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