Daily Sedation Holiday

Daily breaks from sedative infusions have been shown to decrease mortality and shorten hospital stays.^1,2,3 Studies have shown that both lighter sedation and daily sedation holidays for mechanically ventilated patients lower the risk of mortality and complications, such as drug-induced delirium or ventilator associated pneumonia.^1,2,3,4,5,6

Sedation holidays can help avoid drug accumulation and oversedation.³  They may allow your patient time to reorient, and even reduce psychological trauma from critical care stresses.⁷ Finally, they may provide you with an important opportunity to assess your patient’s neurological and respiratory status,¹  as well as his or her readiness to be weaned from sedation and mechanical ventilation.^3,4,5,6

Though some conditions do call for uninterrupted sedation, patients under mechanical ventilation have been shown in studies to require continuous sedation as little as 20% of the time.⁸  Weigh the benefit for each of your patients against the risks—both obvious and subtle. Continuously dosed medication levels can build up over time,³ while sedation depth and adequacy can be difficult to judge, even when using validated rating scales.⁹

In one study, caregivers rated patients as oversedated only 2.6% of the time, though researchers found the same patients minimally or non-arousable in 32% of their assessments and motionless in 21% of their assessments.⁹

A sedation holiday often means first assessing whether the patient passes a safety screen for the break.^5,10 If your patient is deemed ready, you'll most likely stop sedative infusion and allow the patient to awaken fully.⁴  This is usually done each day.^4,10  The duration of this break depends on the patient, the sedative used and your goals for the sedation holiday.^4,10

Generally, you will monitor for signs of discomfort as your patient awakens, and will not restart sedation until after he or she has proven alert and responsive and you have completed your assessment. ^4,10  In "spontaneous awakening trials" and titration protocols, sedation is usually resumed only if or when the patient shows signs of agitation, anxiety, pain or respiratory distress.^4,5,10  In that case, sedation is restarted at a reduced rate or the lowest dose that provides adequate patient comfort.^4,5,10

As a result of daily sedation holidays, you and your patients may see fewer complications and quicker weaning from sedatives and mechanical ventilation.³  Further benefits have been reported with sedation holidays followed by spontaneous breathing trials.^2,4,5,10,11

If you don't have one already, you may consider a standardized program of sedation holidays and assessments to help ensure consistent care for your patients.^4,10