SPICE III

Full title: Sedation Practice in Intensive Care Evaluation 

Aim: investigate if Early Goal-Directed Sedation (EGDS) compared to standard sedation care will reduce delirium (confusion), time on a ventilator and duration of ICU stay and improve survival.

Background: Most patients who need a ventilator to help them breathe require sedation with one or more sedative (calming) drugs given as continuous drip into the vein. Sedative drugs or combinations of drugs are used in the ICU to make patients on ventilators comfortable. Sedative drugs will keep a patient calm but the type used and the way they are given may determine whether or not a patient is deeply or lightly sedated (more or less responsive). Currently, there is no agreement amongst doctors around the world about the best choice of drugs or the best way to manage sedation. Many of the commonly used sedative drugs have side effects and are thought to be associated with longer time on the ventilator, stay in the ICU, delirium (a confused state often including hallucinations) and decreased mental awareness after recovery from critical illness.

Some early research suggests that “light” sedation (where a patient is kept comfortable but responsive) might shorten the time on the ventilator, shorten the ICU stay and result in less delirium.  Dexmedetomidine, midazolam and propofol are all commonly used sedative drugs that can be used alone or in combination, to keep patients comfortable while on a ventilator. These are the sedatives that are usually used in ICUs in the UK.  Recent research has suggested that using dexmedetomidine early as the main sedative drug when the patient is first put on the ventilator may result in lighter sedation, shortening the time on the ventilator and result in less delirium.

Early Goal-Directed Sedation (EGDS) is a sedation management strategy that aims to give the patient “light” sedation e.g. the patient is more easily roused. Dexmedetomidine is the main sedation drug used in EGDS which is given early and as the main sedative drug to achieve the goal of “light” sedation. It is currently unknown if early goal directed sedation is better than standard sedation care and this is what the study is aiming to answer.