Ch 28 (s28.4, s28.14); Ch 49; Ch 57
On ECMO the sedation interruption is not a comfort or weaning issue — it is the only way the primary neurological monitor is switched back on. The ISCCM manual adds that once the patient is stable on the circuit it is prudent to stop all sedation and narcotics to assess neurological status, and the ELSO Red Book that ECLS per se does not mandate sedation.
Standardised sedation protocols with validated scoring systems such as the Richmond Agitation Sedation Scale are recommended. Overall, intermittent (as-needed) analgo-sedation is preferred over continuous infusion. Short-acting, non-benzodiazepine sedatives could be considered. Daily reassessment of sedation goals, stepwise sedation weaning, and sedation interruptions can improve neurological examinations and the diagnosis of acute brain injury.
Sedation as a determinant of neurological assessment