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Study Recommends Waking Patients

May 18, 2000

Patients on life support get out of intensive care sooner if doctors cut off their sedatives long enough for them to wake up each day, according to a study in today’s New England Journal of Medicine.

``Often, these kind of simple, straightforward, pragmatic solutions have more to do with improving outcomes in patients than high-tech, expensive, arcane interventions,″ said Dr. John Heffner at the Medical University of South Carolina, who wrote an editorial accompanying the study.

University of Chicago researchers followed 128 very sick patients breathing through mechanical ventilators.

Such devices push air into the lungs through a tube placed down the throat. But they can make patients uncomfortable and fearful, so sedatives are routinely delivered intravenously.

These calming drugs can accumulate and put patients in a torpor for days. A groggy patient cannot be trusted to start breathing on his own and cannot be properly tested for neurological problems, so sedation can extend the stay in intensive care.

In the study, the patients with daily breaks from sedation stopped using a ventilator after an average of five days and left intensive care within a week. The other patients got off the ventilator in seven days and were out of intensive care in 10 days.

The extra time in intensive care exposes patients longer to such risks as pneumonia, blood clots and lung injury from ventilation.

``They end up being stuck on the ventilator, and being on a ventilator in intensive care is not a safe place to be,″ said Dr. Jesse Hall, a critical care physician who took part in the study.

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On the Net: http://www.njem.com

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