Intermittent versus Continuous Sedation during Mechanical Ventilation in Critically Ill Patient

Abstract

Background :In order to reduce patient pain and agitation during mechanical breathing, sedation has grown to be a crucial component of critical care management (MV). Patients' short-and long-term outcomes will alter as a result of pharmaceutical treatment that is evidence-based. The study's objective is to assess the effects of intermittent and continuous sedation on mechanically ventilated patients' length of stay in the critical care unit, frequency of adverse events, and MV duration. Methods :This randomised clinical research included 100 critically sick patients who had recently needed mechanical ventilation and were anticipated to need it for more than 24 hours. The patients were divided into two groups at random: group A, which received midazolam infusions of 1 to 8 mg/hour or 0.01 to 0.1 mg/kg/hour, titrated to the desired level of sedation, and morphine infusions of 2 to 30 mg/hour when they became agitated with a sedation agitation score (SAS) of 5 or higher. Group B, which received intermittent sedation, received morphine when they became agitated Results : When compared to patients receiving continuous sedation, those receiving intermittent sedation showed considerably greater SAS (P 0.001). Within 3 days of the follow-up, NAS was substantially different and lower when dealing with patients on intermittent sedation as opposed to those on continuous sedation (P values 0.001). When compared to patients receiving continuous sedation (median duration: 105 hr), those receiving intermittent sedation (median time: 47 hr, HR (95 percent CI): 4.686 (2.799: 7.847)), were on MV for a considerably shorter period of time with a greater HR of being extubated (P 0.001). While tracheostomy was not a predictor, the APACHE II score, being reintubated, and the incidence of delirium all significantly predicted the length of MV (coefficient: 2.361, 95 percent CI: 1.175 to 3.548, P0.001, coefficient: 28.411, 95 percent CI: 10.134 to 46.688, P=0.003, and coefficient: 21.222, 95 percent CI: 10.348 to 32.097, P0.001). Conclusions :Patients who had intermittent sedation experienced considerably lower rates of reintubation, NAS, brief MV stays, and longer hospital stays than those under continuous sedation, but significantly greater SAS.