Safety of daily sedation interruptions in mechanically ventilated inner city patients – an alternative approach

Mechanically ventilated patients remain at risk for ventilator-associated pneumonia (VAP). While ventilator bundle implementation, with "sedation vacations" and assessing weaning readiness, has been shown to decrease VAP rates, inadequate sedation is a risk factor for unplanned extubation (UPE). We conducted a before-after observational study after institution of the ventilator bundle with sedation vacations in mechanically ventilated Medical Intensive Care Unit (MICU) patients from January 2006 to December 2007. Patients over 18 years old without contraindications to weaning were included. The primary outcome was UPE rate, and secondary outcomes included days on mechanical ventilation, reintubation, and 28-day mortality. In 2005, 549 of 1196 MICU patients were mechanically ventilated compared to 1179 of 2553 in the study period. UPE rate remained unchanged (5.3% vs. 4.2%; AR -0.010; 95% CI -0.032 to 0.012). There were non-significant decreases in UPE per 100 ventilator days (1.26 vs. 1.04; RR 0.82; 95% CI 0.51 to 1.35; P = 0.40) and duration of mechanical ventilation for patients who had scheduled extubations (3.7 vs. 3.3 days; 95% CI -0.02 – 082; P = 0.06). This study suggests that sedation interruptions and assessment for weaning are safe in our unique inner city population and do not result in increased UPE rates.