- Design
- Cochrane systematic review and meta-analysis of 23 randomised trials
- Population
- 5,987 mechanically ventilated adults and children
- Primary outcome
- Ventilation duration, mortality, ICU length of stay
- Effect
- Mortality RR 0.88 (0.77–0.99); tracheostomy RR 0.68 (0.55–0.85); ICU stay −11%
The updated Cochrane review, published 7 October, pooled 23 randomised trials of daily sedation interruption (DSI) in nearly 6,000 mechanically ventilated adults and children, against protocolised sedation, usual care or analgesia-first strategies.
DSI probably reduced mortality (risk ratio 0.88, moderate certainty), and probably shortened ICU and hospital stays by about 11%. It probably reduced tracheostomy (risk ratio 0.68). It may shorten ventilation by about 14%, though trials disagreed. Accidental extubation was not clearly more common. Morphine use rose slightly, and the delirium effect was very uncertain.
A moderate-certainty mortality signal makes DSI a practice to embed rather than an option, particularly in units without a robust nurse-led sedation protocol. Light sedation with a daily awakening check remains the aim.
- Build a daily sedation hold into ventilated patients' routine, with a safety screen
- Pair it with a spontaneous breathing trial
- Expect fewer tracheostomies and shorter stays
- Accidental extubation was not clearly increased, but keep close observation during the hold
- Audit compliance; benefit depends on the hold actually happening
Why it matters
Mortality and tracheostomy benefits now sit behind a cheap, nurse-deliverable intervention.
Don't overread it
Moderate certainty for mortality — the comparators varied, and the benefit may be smaller where sedation is already light.
The statistics, in plain English
RR 0.88 (95% CI 0.77 to 0.99) with I² of 0% means trials agreed, but the upper limit near 1 shows the benefit could be small. The ventilation result has I² of 88%, so trials disagreed a lot and that estimate is less reliable.
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