0
Editorials: Point/Counterpoint Editorials |

Rebuttal From Dr KressRebuttal From Dr Kress

John P. Kress, MD
Author and Funding Information

From the Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago.

Correspondence to: John P. Kress, MD, Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, 5841 South Maryland Ave, MC 6026, Chicago, IL 60637; e-mail: jkress@medicine.bsd.uchicago.edu


Financial/nonfinancial disclosures: The author has reported to CHEST 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(5):1095. doi:10.1378/chest.12-1996
Text Size: A A A
Published online

Extract

Dr Vinayak1 offers important arguments regarding the minimization of sedation, a trend that has been present in the published literature for more than a decade. However, it is important to look at the practical options for this changing philosophy in sedation strategies. He cites the important study by Strøm et al,2 referred to as “no sedation.” A couple of aspects regarding this study deserve comment. First, patients in this trial who were randomized to the intervention group received morphine, rather than sedatives, as their foundational strategy. Morphine is an opiate analgesic drug. Although not in the category of pharmacologic sedatives, this drug certainly has a “calming” effect on patients who are mechanically ventilated. It is rare that a patient can be managed without any drug, at least not in the early stages of respiratory failure. Second, this study was performed in Denmark, where ICU nursing to patient ratios were universally 1:1. This luxury is very rare in the rest of the world and is certainly a practical limitation to the widespread institution of the “no sedation” strategy. Furthermore, a person who can be summoned to provide verbal reassurance in the event that a patient is agitated is not a reality in most busy ICUs around the world. Last, one of five patients in this study could not tolerate this “no sedation” strategy. Accordingly, this study, although impressive, has important practical limitations. Survival from critical illness is improving substantially. For these reasons, the reality is that sedatives will continue to be necessary for the foreseeable future for managing patients who are mechanically ventilated.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
Propofol vs Midazolam for ICU Sedation*: A Canadian Multicenter Randomized Trial
PubMed Articles
Guidelines
Acute confusion/delirium.
University of Iowa College of Nursing, John A. Hartford Foundation Center of Geriatric Nursing Excellence
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543