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Rebuttal From Dr Ely et alRebuttal From Dr Ely et al

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):287-289. doi:10.1378/chest.12-1190
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Dr Skrobik’s1 counterpoint editorial does an excellent job of describing many of the characteristics that make benzodiazepines such a poor choice for sedation in the ICU, including delayed clearance and prolonged awakening, especially in patients with kidney injury, liver dysfunction, or advanced age (all common among patients in the ICU); tremendous variability in response; and alterations in metabolism when coadministered with many medications used in the ICU. We agree with her that benzodiazepines lack the characteristics of an ideal ICU sedative.

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