Failure of non-sedation strategy in critically ill, mechanically ventilated patients - a retrospective, post-hoc analysis of the NONSEDA trial

Nedergaard, Helene Korvenius; Korkmaz, Serkan; Olsen, Hanne Tanghus; Jensen, Hanne Irene; Strøm, Thomas; Toft, Palle

doi:10.1016/j.jcrc.2021.12.001

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…42.8% of those randomised to the non-sedation arm experienced "failure of non-sedation" according to the authors. These patients, primarily male, required rescue sedation, and had longer ICU and hospital stays, and fewer days alive without sedation, coma, delirium, organ support, or mechanical ventilation, though mortality and long-term outcomes did not differ between non-sedation "failures" and "successes" [50].…”

Section: Light Sedation Should Be the Normmentioning

confidence: 98%

Sedation management in the post-COVID era: A personalised, patient-orientated approach

John Glassford,

Shehabi

2024

Clin Crit Care

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Intensive care patients are older, frailer, and more co-morbid than ever before, and remain at risk of a variety of adverse outcomes, both in ICU, and after discharge. Sedation and delirium play an intricate role in this complex system, and it can be difficult to determine if they are a contributor or consequence in any given situation. During the COVID-19 pandemic, the increased frequency of complex ventilatory management, including prone ventilation and neuromuscular blockade, necessitated deep sedation in many cases. In concert with infection control concerns and staffing pressures, the delivery of precision symptom- and patient-oriented sedation has waned in favour of strategies felt to be globally safe. Using the SPICE III study as a lens to understand both the importance of exploring heterogeneity of effect in large, complex RCTs of critically ill patients, and the importance of an individualised approach to sedation in the intensive care unit, we demonstrate the evolution of our understanding of sedation in this challenging environment. By following the principles that define the cornerstones of best contemporary sedation practice we can once more grow beyond the boundaries of clinical practice guidelines in the provision of personalised, patient-orientated sedation in the post-COVID intensive care unit.

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Section: Light Sedation Should Be the Normmentioning

confidence: 98%

Sedation management in the post-COVID era: A personalised, patient-orientated approach

John Glassford,

Shehabi

2024

Clin Crit Care

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“…Reducing unnecessary equipment usage may correspondingly reduce the risk of pressure ulcers in critically ill patients. A retrospective analysis of failed nosedation strategies in critically ill mechanically ventilated patients found that successful nosedation was associated with better hospital outcomes, while mortality and long-term outcomes were not affected by the success or failure of nosedation [18]. In conclusion, further randomized controlled trials are necessary to determine the most appropriate sedation strategy: deep seda-C. P. Wang, F. Li Journal of Biosciences and Medicines tion, light sedation, or no sedation.…”

Section: Target Goal Of Sedationmentioning

confidence: 99%

Postoperative Sedation Options in ICU

Wang,

2024

JBM

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This paper examines sedation options in ICU postoperative care. It highlights the necessity of sedation for patients' physical and mental comfort, safety, and reduction of delirium. The article advocates light sedation, primarily with non-benzodiazepines like propofol or dexmedetomidine, to improve outcomes. It introduces novel sedatives like ciprofol and remimazolam, suggesting they may be future alternatives in ICU sedation, although more research is needed.

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Multimodal, patient-centred symptom control: a strategy to replace sedation in the ICU

Eikermann

Devlin

2023

The Lancet Respiratory Medicine

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Failure of non-sedation strategy in critically ill, mechanically ventilated patients - a retrospective, post-hoc analysis of the NONSEDA trial

Cited by 3 publications

References 10 publications

Sedation management in the post-COVID era: A personalised, patient-orientated approach

Sedation management in the post-COVID era: A personalised, patient-orientated approach

Postoperative Sedation Options in ICU

Multimodal, patient-centred symptom control: a strategy to replace sedation in the ICU

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