Daily sedation interruption probably saves lives in ventilated patients

The edition in brief

The updated Cochrane review of daily sedation interruption pooled 23 trials and nearly 6,000 ventilated adults and children. Compared with sedation strategies without a daily hold, interruption probably reduced mortality (risk ratio 0.88, moderate certainty), shortened intensive care and hospital stays by about 11%, and reduced tracheostomy by about a third, without clearly more accidental extubations; it may shorten ventilation by about 14% at low certainty. The phase 3 STArT trial of intravenous arginine in 271 children and young adults with sickle cell pain crises was stopped for futility: time to crisis resolution did not differ. A US emergency department cohort of 1,147 adults discharged with pyelonephritis found similar 14-day failure, about 18% to 20%, whether they received a first-, second- or third-generation oral cephalosporin. In a statewide Australian registry of paramedic-suspected STEMI, 60% had STEMI confirmed, and those with non-cardiac final diagnoses had higher long-term mortality. A meta-analysis of 13 trials links open ICU visiting to about half the rate of delirium, at low certainty. The pearl covers how to run a sedation hold safely.