Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Department of Anaesthesiology and Intensive Care, Ospedale San Raffaele, Milan, Italy (Drs Zambon, Bergonzi, and Colombo; Zambon.firstname.lastname@example.org).
To the Editor: In the study by Dr Mehta and colleagues,1 we have some concerns about the implementation of the protocols used. The degree of sedation in patients who are mechanically ventilated should provide them comfort and allow their cooperation. In this trial, physical constraints were used in 76% of patients in the daily interruption group and in 79% of patients in the continuous sedation group. Could the degree of sedation have been too light to provide comfort or too deep to allow the patient's cooperation? Physical constraints are often seen as a negative tool by families and patients. Even with physical constraints, the unintentional extubation rate was quite high.
Zambon M, Bergonzi PC, Colombo S. Sedation Interruption for Mechanically Ventilated Patients. JAMA. 2013;309(10):982-983. doi:10.1001/jama.2013.998