Interruption of sedation for early rehabilitation improves outcomes in ventilated, critically ill adults.

Question: Does early provision of rehabilitation improve the likelihood of functional independence at discharge in ventilated, critically ill patients? Design: Randomised, controlled trial with concealed allocation and blinded assessment of some outcomes. Setting: Two tertiary medical centres in the USA. Participants: Adults in a medical intensive care unit (ICU) who had been on mechanical ventilation for less than 72 hours and were expected to continue for at least another 24 hours, and who had been functionally independent two weeks before admission. Exclusion criteria included: rapid onset neuromuscular disease, cardiopulmonary arrest, irreversible disorders with high mortality, and raised intracranial pressure. Randomisation of 104 participants allotted 49 to receive the early intervention and 55 to a control group. Interventions: Both groups received sedation guided by the Richmond Agitation Sedation Scale and underwent daily interruption of sedatives or narcotics or both, unless contraindicated. Weaning from mechanical ventilation and insulin for glycaemic control were also protocol-directed. During the daily interruption of sedation, the intervention group commenced rehabilitation as appropriate to their clinical status: passive movements for those who were unresponsive, Interruption of sedation for early rehabilitation improves outcomes in ventilated, critically ill adults