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Communications to the Editor |

Continuous IV Sedation and Mechanical Ventilation FREE TO VIEW

Moshe Hersch, MD; Shoshana Zevin, MD
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Director, Intensive Care Unit Division of Internal Medicine and Clinical Pharmacology Service Shaare Zedek Medical Center Jerusalem, Israel



Chest. 1999;115(4):1220. doi:10.1378/chest.115.4.1220
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To the Editor:

We read with interest the paper by Kollef and colleagues1and the accompanying editorial comment. We think that paralyzed patients are a separate group and should not be included in the continuous sedation group, because those patients particularly need continuous sedation while being paralyzed. Additionally, although the paralysis effect on weaning was neutralized with the usual statistical maneuvers, every intensive care practitioner knows that those patients are so much more difficult to wean, especially if they had been receiving steroids as well. Since the treatment allocation was not randomized, it is possible that the patients receiving continuous sedation were the ones who could not be controlled by bolus sedation, thus introducing a bias. Since no scores of the efficacy of analgesia and sedation are provided in this study, it is hard to make meaningful comparisons between the two methods of sedation. However, there are some indications that sedation and analgesia on an “as needed” basis may be inadequate.2,,3

The emotional editorial comment is very moving, but far from being practical or realistic. In our opinion, it is much more inhuman to maintain these patients conscious and aware of their traumatizing ICU experience, rather than to optimally sedate them. The use of continuous sedation avoids breakthrough discomfort and pain, as well as unnecessary extubations or line dislodgments, and it also induces“ blessed” amnesia. The luxury of 1:1 nurse:patient ratio is not possible in many ICUs; the nurse has really no time for long“ sedative” talks with her two patients. However, the patients benefit from the tranquilizing effects of the drugs, which also prevent many unwarranted accidents caused by patients’ restlessness and the inability of one nurse to adequately control two patients at once, even at the price of a longer weaning period.

Correspondence to: Moshe Hersch, MD, Director, Intensive Care Unit, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel; e-mail: hersch@szmc.org.il

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. [PubMed] [CrossRef]
 
Dasta, JF, Fuhrman, TM, McCandles, C Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit.Crit Care Med1994;22,974-980. [PubMed]
 
Tittle, M, McMillan, SC Pain and pain-related side effects in an ICU and on a surgical unit: nurses’ management.Am J Crit Care1994;3,25-30. [PubMed]
 

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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. [PubMed] [CrossRef]
 
Dasta, JF, Fuhrman, TM, McCandles, C Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit.Crit Care Med1994;22,974-980. [PubMed]
 
Tittle, M, McMillan, SC Pain and pain-related side effects in an ICU and on a surgical unit: nurses’ management.Am J Crit Care1994;3,25-30. [PubMed]
 
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