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ICU Sedation Strategy — FRCA Final MCQ

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ModerateIntensive Care MedicineICU Sedation StrategyFRCA Final

A 55-year-old man (ASA III) on the ICU has been sedated with propofol and alfentanil for 5 days. He is being assessed for sedation hold. The Richmond Agitation-Sedation Scale (RASS) target is -1 to 0. His current RASS is -4. According to evidence from the SLEAP and ABC trials, what is the recommended approach to sedation in ICU?

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Correct answer: E — Daily sedation interruption (DSI) combined with spontaneous breathing trials

The ABC trial (Girard et al, 2008) demonstrated that combining daily sedation interruption (wake-up protocol) with spontaneous breathing trials significantly reduces duration of mechanical ventilation, ICU length of stay, and mortality compared to either strategy alone. Light sedation (RASS -1 to 0) is associated with better outcomes than deep sedation. Current ICS guidelines recommend protocolised sedation with regular assessment using validated tools (RASS, CAM-ICU for delirium).

Reference: Girard TD et al – 2008 – ABC trial; ICS – 2023 – Guidelines for sedation in the ICU