Protocol-Directed Sedation Versus Non–Protocol-Directed Sedation to Reduce the Duration of Mechanical Ventilation in Intensive Care Patients

What are the effects of protocol-directed sedation management on the duration of mechanical ventilation and other relevant patient outcomes in patients receiving mechanical ventilation in intensive care units (ICUs)?

The short- and long-term effects of suboptimal sedation management, such as increased incidence of delirium, agitation, self-extubation, or increased ICU length of stay, have been seen with both over- and undersedation. The evidence of poor sedation practices is growing in the literature, with a previous systematic review of 36 studies finding a significant incidence of suboptimal sedation.¹  Currently, practitioners have implemented a wide variety of approaches to manage sedation in patients receiving mechanical ventilation, such as formal sedation assessment tools, prescribed targets for level of sedation and assessment frequency, sedation administration guidelines, daily sedation interruptions, the use of minimum effective dosages, extubation readiness assessments, standardized management of ventilator settings, and delirium screenings.²  Despite multiple accounts of protocolized sedation management,...