Background: Ventilator-associated pneumonia (VAP) is a common side effect in patients who receive intravenous sedation infusion. In routine care, after starting sedation infusion for patients who receive mechanical ventilation, interruption of sedation starts without protocol. This study aimed to evaluate the effect of daily sedation vacation protocol on the incidence of VAP in mechanically ventilated patients. Materials and Methods: In this clinical trial study, 80 patients with intravenous sedation infusion were selected and randomly allocated to intervention and control groups. In the intervention group, daily sedation vacation protocol and in the control group, routine sedation vacation was followed. Modified clinical pulmonary infection score questionnaire was completed before intervention and on the third, fourth, and fifth days after intervention. Data were analyzed by using repeated measures analysis of variance (ANOVA), Chi-square, and independent t-test. Results: The results of this study showed that the incidence rate of VAP in the intervention and control groups was 0% versus 15% on the third day of intervention, 12.5% versus 50% on the fourth day, and 27.5% versus 55.3% on the fifth day of intervention in the intervention and control groups, respectively. The incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05). Conclusions: The results of this study showed that in patients with intravenous sedation, infusion of a daily sedation vacation protocol may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to use this daily sedation vacation protocol.

Daily sedation interruption (DSI) is a method used since the beginning of the millennium to streamline sedation in critically ill patients under mechanical ventilation and improve clinical outcomes. The purpose was to assess whether there is a correlation between DSI and weaning from mechanical ventilation. We designed a literature review via searching PubMed, UpToDate and Google Scholar for relevant key terms from inception until March 2019. Literature retrieved included nine randomized controlled trials. When compared to usual practice, it is superior in terms of duration of mechanical ventilation, stay in the intensive care unit, hospitalization, adverse effect occurrence and total cost of therapy. Comparison with other sedation protocols produces conflicting results. DSI, and protocolized sedation in general, are safe methods to perform to facilitate earlier weaning and improved clinical outcomes. Future research should focus on minimizing bias by conducting double-blinded studies and studying different patient subgroups.

The clinical approach to sedation in critically ill patients has changed dramatically over the last two decades, moving to a regimen of light or non-sedation associated with adequate analgesia to guarantee the patient's comfort, active interaction with the environment and family, and early mobilization and assessment of delirium. Although deep sedation (DS) may still be necessary for certain clinical scenarios, it should be limited to strict indications, such as mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS), status epilepticus, intracranial hypertension, or those requiring target temperature management. DS, if not indicated, is associated with prolonged duration of mechanical ventilation and ICU stay, and increased mortality. Therefore, continuous monitoring of the level of sedation, especially when associated with the raw EEG data, is important to avoid unnecessary oversedation and to convert a DS strategy to light sedation as soon as possible. The approach to the management of critically ill patients is multidimensional, so targeted sedation should be considered in the context of the ABCDEF bundle, a holistic patient approach. Sedation may interfere with early mobilization and family engagement and may have an impact on delirium assessment and risk. If adequately applied, the ABCDEF bundle allows for a patient-centered, multidimensional, and multi-professional ICU care model to be achieved, with a positive impact on appropriate sedation and patient comfort, along with other important determinants of long-term patient outcomes.

<h4>Importance</h4>The effectiveness of daily sedation interruption (DSI, defined as temporary interruption of sedation) has yet to be demonstrated in critically ill pediatric patients.<h4>Objective</h4>To compare the clinical outcomes of DSI vs continuous intravenous (IV) sedation in patients receiving invasive mechanical ventilation (MV) support in the pediatric intensive care unit (PICU).<h4>Data sources</h4>A systematic search for studies was conducted using predefined keywords and Medical Subject Headings in 5 major databases (PubMed, Embase, Web of Science, CINAHL [Cumulated Index to Nursing and Allied Health Literature], and Cochrane Central Register of Controlled Trials) from database inception to October 31, 2023.<h4>Study selection</h4>Retrospective and prospective observational studies, randomized clinical trials (RCTs), and systematic reviews were assessed for inclusion. Studies were eligible if they compared DSI to continuous IV sedation in patients aged 18 years or younger requiring MV in the PICU.<h4>Data extraction and synthesis</h4>Study characteristics, including the types of sedation, sedation protocols, and clinical outcomes, were extracted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was followed. A random-effects model was used to pool results from articles for the meta-analysis.<h4>Main outcomes and measures</h4>The primary outcomes of interest were duration of MV and length of PICU stay. Secondary outcomes included total sedative dose requirement, adverse events (eg, complications associated with MV, withdrawal, and delirium), and mortality.<h4>Results</h4>A total of 6 RCTs with 2810 pediatric patients (1569 males [55.8%]; mean age, 26.5 [95% CI, 15.0-37.9] months) were included in the final analysis; patients had a mean PRISM (Pediatric Risk of Mortality) score of 13.68 (95% CI, 10.75-16.61). Compared with continuous IV sedation, DSI was associated with a reduction in length of PICU stay (5 studies, n = 2770; mean difference [MD], -1.45 [95% CI, -2.75 to -0.15] days; P = .03]. There was no difference in MV duration (5 studies, n = 2750; MD, -0.93 [95% CI, -1.89 to 0.04] days; P = .06), total doses of midazolam (3 studies, n = 191; MD, -1.66 [95% CI, -3.95 to 0.63] mg/kg) and morphine used (2 studies, n = 189; MD, -2.63 [95% CI, -7.01 to 1.75] mg/kg), or adverse events (risk ratio [RR], 1.03 [95% CI, 0.74-1.42]; P = .88). There was no difference in mortality between patients exposed vs not exposed to DSI (RR, 0.89 [95% CI, 0.55-1.46]; P = .65).<h4>Conclusions and relevance</h4>This systematic review and meta-analysis found that use of DSI in pediatric patients was associated with reduced length of PICU stay with no increase in adverse events. Further research is needed to ascertain whether this strategy is associated with improved neurodevelopmental outcomes in PICU survivors.

Sedation management in critically ill children is challenging, with continuous infusions often leading to oversedation, prolonged mechanical ventilation, and iatrogenic withdrawal syndrome. Daily sedation interruption (DSI) is a strategy to mitigate these risks, but evidence regarding its efficacy and safety in the pediatric population is conflicting. This systematic review and meta-analysis aimed to evaluate the impact of DSI versus continuous sedation on clinical outcomes in mechanically ventilated pediatric patients. A systematic search of PubMed, Embase, and CENTRAL was conducted to identify randomized controlled trials (RCTs) comparing DSI with continuous sedation in children (0-18 years). The primary outcome was the duration of mechanical ventilation. Secondary outcomes included length of stay (LOS) in the pediatric ICU (PICU), total drug exposure, sedation depth, and adverse events. Data were pooled using a random-effects model. Trial sequential analysis (TSA) was performed to assess the sufficiency of the evidence, and the certainty of evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Six RCTs comprising 2,810 patients were included. In the pooled analysis, DSI was associated with a reduction in the duration of mechanical ventilation (mean difference (MD) -1.01 days; 95% CI -2.07 to 0.05; p = 0.06) and PICU LOS (MD -0.85 days; p = 0.31), though neither reached statistical significance. Significant heterogeneity was observed (I²= 51.8%). Subgroup analysis revealed that DSI reduced ventilation time in studies with a nonstandardized control group (MD -1.85 days) but offered no benefit over protocolized sedation (MD -0.41 days). No significant differences were found in mortality (risk ratio (RR) 1.08), accidental extubation (RR 0.89), or re-intubation rates (RR 0.85). TSA indicated that the current evidence is inconclusive, having not met the required information size to detect a 1.5-day reduction in ventilation. DSI is safe in critically ill children but does not consistently reduce the duration of mechanical ventilation compared to modern protocolized sedation care. Its utility may be greatest in resource-limited settings lacking robust sedation titration protocols. Given the low certainty of current evidence, DSI should be considered a component of multimodal sedation management rather than a standalone standard of care.

Introduction: Mechanical ventilation is a critical intervention in intensive care units, yet prolonged ventilation increases complications including ventilator-associated pneumonia, delirium, and mortality. Daily sedation interruption (DSI) has been proposed as a strategy to reduce ventilation duration, but evidence remains inconsistent. Methods: A systematic review and meta-analysis was conducted searching PubMed, Embase, Cochrane Library, and Web of Science from inception to March 2024. Randomised controlled trials (RCTs) and observational studies comparing DSI with continuous sedation were included. The primary outcome was duration of mechanical ventilation. Pooled standardised mean difference (SMD) and 95% confidence intervals (CI) were calculated using Hedges’ g with a random-effects model. Heterogeneity was assessed using I² statistics, and subgroup analyses stratified by intensive care unit type and study design. Results: Ten studies comprising 2,011 participants were included. Pooled SMD for ventilation duration was −0.3655 (95% CI −0.7611 to 0.0301; p = 0.0662), indicating a non-significant trend favouring DSI, with very high heterogeneity (I² = 91.54%). Subgroup analysis in general intensive care units (three studies, n = 426) demonstrated significant reduction in ventilation duration (SMD = −0.6763, 95% CI −0.1265 to −0.2262; p = 0.0231; I² = 20.38%), whereas medical (three studies) and medical-surgical (three studies) units showed non-significant effects. Sensitivity analysis indicated robustness of findings when studies by Nassar Jr and Mehta (2016) were sequentially excluded. Conclusion: Daily sedation interruption showed a non-significant trend towards reducing mechanical ventilation duration in pooled analysis, with significant benefit demonstrated specifically in general intensive care units. High heterogeneity suggests practice variation in DSI protocols and patient populations influences outcomes. Future standardised DSI protocols and trials in homogeneous populations are warranted.

To prospectively assess the effect of remifentanil for analgesia and sedation, the impact on sustenance duration of mechanical ventilation and hemodynamics, and also its adverse reaction in the mechanically ventilated patients in the intensive care unit (ICU).Sixty patients with invasive mechanical ventilation forever 24 hours after tumor operation were randomly allocated to fentanyl group (n = 30) or remifentanil group n = 30) to receive a persistent infusion of either fentanyl or remifentanil for sedation and analgesia. The level of analgesia was assessed according to facial pain scale (FPS), while the level of sedation was assessed according to the Ramsay score (RS). A propofol infusion was started if additional sedation was necessary. During the therapy, the daily awakening procedure was performed, and the scores of FPS and RS and the vital signs were recorded respectively before and after medication. The number of patients receiving additional propofol infusion, and number of daily interruption of medication and that of daily arousal, the duration of mechanical ventilation, ICU length of stay, and ICU cost were recorded. Furthermore, the incidence of adverse reactions was documented.The ideal targets of analgesia and sedation were reached in both groups. There were nearly no significant differences between the groups with respect to the effect of sedation and analgesia. However, the FPS scores in fentanyl group at the 30 minutes of the medication were. obviously higher t

Mechanically ventilated children in the PICU frequently require prolonged exposure to opioids and sedatives. This can lead to oversedation, longer duration of mechanical ventilation, and complications such as IWS and delirium. IWS has an incidence between 35-50% in patients with prolonged sedation. Daily sedation interruption (DSI) may further reduce the sedative burden by limiting bioaccumulation and promoting daily reassessment; however, pediatric evidence remains heterogeneous and IWS has been insufficiently addressed as a primary endpoint. OBJECTIVE: The primary objective of the study is to determinate whether DSI to a protocolized sedative rotation strategy reduces the incidence of IWS in PICU patients aged 2 to 16 years, in mechanically ventilated for more than five days, compared with sedative rotation alone. STUDY DESIGN AND PARTICIPANTS: This is a multicentre, parallel group, randomized controlled trial conducted in level II and III PICU. Prior to study initiation, participating centres will undergo standardized training sessions to harmonize sedation protocols, safety criteria and use of assessment tools. The study is open label, with blinded outcome assessment and statistical analysis. The planned sample size is 336 patients, and randomization will be stratified by age group (2-4,5-9,10-16 years). METHODS: Participants will be randomized 1:1 to control with protocolized sedative drug rotation without DSI, or intervention with the same rotation protocol plus once da

The aim of this study is to analyze the current approaches in sedation and analgesia practices among pediatric intensive care units’ (PICUs) patients. Methods: This is a descriptive prospective study reviewing 80 pediatric patients admitted to PICUs of Cairo university hospitals over 6 months, describing their sedo-analgesia practice, indication, duration, dose, effect and side effects.Results: Eighty pediatric patients were enrolled, with a median age of 5.5 months, 51% of them were females (n= 41), and their weight ranged from 2.4 kg to 80 kg with a median of 6 kg. Pneumonia (53.8%) was the most common indication for admission with 49 patients needed mechanical ventilation showing the highest percentage (60%) among the indications of the sedation. Fentanyl used in 43.8%, 36% of patients needed multimodal medications, good sedation achieved in (67.5%), reduction of pain ranged from 44.44% to 100%. The median duration of PICU stay was 9.5 days. Vomiting presented in 15 % representing the most common side effect of sedo-analgesic use. Vital signs were found to be statistically significant indicator in assessing the efficacy of sedation and analgesia.Conclusion: The practice of adequate sedation and analgesia in PICUs is a fundamental tool; it improves our patients’ vital signs, reduces pain, facilitates synchronization with mechanical ventilation and decreases the length of stay in post-operative patients. Enhancing the proper use of sedation and analgesia in PICUs for better