Critically ill postoperative patients far better when sedation is interrupted as soon as possible after admission to the ICU, compared with usual sedation care, according to results from the SOS-Ventilation trial.

While caring for a critically-ill patient, avoiding unnecessary sedation and prolonged mechanical ventilation is considered as the best practice recommendation. However, data on these recommendations are not available for critically-ill postoperative patients.

Dr. Chanques and colleagues from France performed the SOS-Ventilation trial to evaluate whether immediate cessation of sedation could improve postoperative outcomes compared with usual sedation care. Este was a randomized trial which included a total of 137 patients who I was admitted to one of three ICUs after abdominal surgery.

All patients were expected to require at least 12 hours of mechanical ventilation for critical illness, defined by a Sequential Organ Failure Assessment score> 1 for any organ, but without severe respiratory distress syndrome or brain injury.

Continuous sedation was stopped 15 minutes after randomization in the immediate-interruption group, vs. 33 hours in the control group. The primary outcome of the study was the time to successful extubation (defined as the time from randomization to the time of extubation [or tracheotomy mask] for at least 48 h).

The primary outcome was significantly shorter with immediate interruption (8 hours) than usual care (50 hours). Fewer patients in the immediate-interruption group than the usual-care group developed coma (15 vs. 34) or delirium (28 vs. 48), and the intervention group had significantly more delirium-free days (median, 28 vs. 26 days).

"This strategy needs further studies to assess its feasibility and its impact in other patient populations, such as (those) undergoing different surgical interventions than abdominal surgery, patients after intubation and achievement of invasive procedures, patients with a more severe acute lung injury , and so on, "Dr. Chanques said.