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Summary of the Kress 2000 Trial
Medical ICU patients receiving continuous infusion sedation with daily interruption were liberated from mechanical ventilation and left the ICU quicker, but this effect did not translate to a shorter hospital course or a mortality benefit.
Key Points from Kress 2000
- Included 128 mechanically ventilated patients in a single-center medical ICU
- All patients received morphine infusions for analgesia, randomized to either midazolam or propofol infusions for sedation, and again randomized to either “daily interruption” or standard of care
- Daily interruption protocol: Each day, morphine and sedative infusions were stopped until the patient was awake and could follow commands or became agitated. “Awake” was defined as following 3 of the 4 actions: open eyes to voice, use eyes to follow investigator on request, squeeze hand on request, stick out tongue on request.
- Primary endpoints were duration of mechanical ventilation, ICU and hospital length of stay
- Daily awakening decreased duration of mechanical ventilation (4.9 vs. 7.3 days, p=0.004) and ICU length of stay (6.4 vs. 9.9 days, p=0.02). There was no difference in hospital length of stay or mortality.
- The benefit of time on the vent and ICU length of stay was significant in both midazolam and propofol arms
- Patients with daily interruption had fewer diagnostic scans to assess mental status (6 vs. 16 tests, p=0.02) and did not have a higher incidence of self-extubation or self-removal of central lines
Kress JP, Pohlman AS, O’Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000 May 18;342(20):1471-7. PMID 10816184