A daily sedation hold works only when it is paired with assessment and a plan. Screen first: hold off in active seizures, alcohol withdrawal, escalating sedation for agitation, neuromuscular blockade, raised intracranial pressure or myocardial ischaemia.
Stop sedative infusions, keep analgesia running, and stay close. The patient passes when they open their eyes to voice and follow simple commands, or tolerate the hold for several hours without distress. If they fail — sustained agitation, distress, desaturation or arrhythmia — restart at half the previous dose and titrate.
Pair a passed hold with a spontaneous breathing trial the same morning.
- Screen for contraindications before every hold
- Keep analgesia running; stop sedative infusions only
- Restart at half dose if the hold fails
- Follow a passed hold with a spontaneous breathing trial
Why it matters
A hold done without a plan risks self-extubation and is quietly abandoned on busy units.
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