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Point: Should Benzodiazepines be Avoided in Mechanically Ventilated Patients? YesAvoid Benzodiazepines With Mechanical Ventilation

E. Wesley Ely, MD, MPH, FCCP; Robert S. Dittus, MD, MPH; Timothy D. Girard, MD, MSCI
Author and Funding Information

From the Division of Allergy, Pulmonary, and Critical Care Medicine (Drs Ely and Girard), the Center for Health Services Research (Drs Ely, Dittus, and Girard), and the Division of General Internal Medicine and Public Health (Dr Dittus), Department of Medicine, Vanderbilt University School of Medicine; and Geriatric Research, Education and Clinical Center Service (Drs Ely, Dittus, and Girard), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System.

Correspondence to: E. Wesley Ely, MD, 6109 Medical Center E, Vanderbilt University, Nashville, TN 37232-8300; e-mail: wes.ely@vanderbilt.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Ely consulted for Hospira, Inc; Cumberland Pharmaceuticals, Inc; and Masimo Corporation; received honoraria for nonpromotional speaking from Hospira, Inc; and received a grant from Hospira, Inc and Eli Lilly and Company. Dr Girard received honoraria for nonpromotional speaking from Hospira, Inc. Dr. Dittus has reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(2):281-284. doi:10.1378/chest.12-1189
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All too often, patients who are mechanically ventilated in the ICU find themselves drowning in the abyss of an imperfect, and sometimes iatrogenic, sea of intensive care. We provide therapy, including sedation, with benevolent intent, but harm often follows. We can do better. The Institute of Medicine recommends, amid other sage advice, that care be safe, effective, timely, patient centered, equitable, and efficient. This means the right care in the right way at the right time for the right person, every time for everyone. Individualizing care is critical to this goal, and nowhere more so than in ICU sedation. Whereas benzodiazepines are helpful in managing patients with alcohol withdrawal or status epilepticus, for sedation of the mechanically ventilated patient (the most common indication for benzodiazepine use in the ICU), the evidence clearly shows that the safest and most effective care requires an overhaul of the “sleepy” culture of benzodiazepine sedation in the ICU.

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