High-risk critically ill patients often require mechanical ventilation either to primarily
support the respiratory function or when the ventilation is insufficient to maintain adequate
gas exchanges as a result of other organ impairment. In order to tolerate this aggressive
mechanical support, enhance patient synchrony with the ventilator, and relieve pain and
anxiety, analgesia and sedation are provided. It is suggested that an inappropriate use of
sedation and analgesia may prolong the duration of mechanical ventilation and increase the
risk of specific adverse outcomes such as ventilator associated pneumonia. Despite the
widespread use of sedation, little information is available concerning the effect of varying
the level of sedation on patients' subsequent mental health. We designed a randomized
controlled trial to investigate the efficacy of sedation with the goal of maintaining the
patient cooperative and interactive compared to the administration of sedation with the goal
of maintaining the patient sedated. The first goal will be achieved by a discontinuous
injection of a sedative, while the second goal will be achieved by a continuous infusion of
the same sedative. In both groups pain relief will be provided in the same fashion with equal
endpoints on a pain scoring scale. Our primary aim is to investigate whether differences in
the occurrence of post-traumatic stress disorders (PTSD), anxiety, and depression are related
to the choice of sedation-analgesia strategies. Secondary endpoints include the length of ICU
stay, as indicated by the time to discharge from the ICU, the time to separation from
mechanical ventilation, the rates of pulmonary and extra-pulmonary complications, and
hospital length of stay. These endpoints will be compared between the two groups.