INTERMITTENT  DOSING

Intermittent dosing of analgesics and anxiolytics, as opposed to continuous dosing, has been shown to reduce the duration of mechanical ventilation and intermittent dosing of analgesics and anxiolytics should be instituted prior to continuous dosing. Although many sedative agents are utilized for their short duration of action (e.g. midazolam), administration as a continuous infusion will often result in a prolonged duration of action and effect due to fat storage an accumulation of active metabolites. It is recommended that intermitted sedation be used whenever feasible. For patients who require dosing more frequently than every 1-2 hours, continuous dosing titrated to effect can be used; however, continuous infusions should be converted to intermittent dosing as early as possible.

SEDATION  VACATIONS

Daily interruptions of sedation (“sedation vacations”) have repeatedly demonstrated reduction in the duration of mechanical ventilation as well as the incidence of ventilator-associated pneumonia.21  Intermittent dosing and daily sedation holidays prevent the accumulation of active metabolites, which may impede patient assessment for prolonged periods of time.25,28

CONTRAINDICATIONS  TO  THE  DAILY  SEDATION  HOLIDAY:

See Appendix H for a sample order set including medication options and dosing.

See Table 1 in Appendix A for suggested management algorithms.