Maintaining light sedation is important: next steps for research.

Critically ill adults are frequently administered continuous sedative and/or opioid infusions, based on clinicians’ intentions of optimising comfort, facilitating mechanical ventilation and promoting safety.1 Deep sedation, more prevalent during the current SARS-CoV-2 pandemic,2 is associated with coma, delirium and muscle weakness, with associated impairments in survival and physical, cognitive and mental health.1 The 2013 Pain, Agitation and Delirium (PAD) guidelines made an ungraded statement that using a sedation protocol (SP) to target light levels of sedation or instituting Spontaneous Awakening Trials (SAT) will improve short-term outcomes (eg, duration of mechanical ventilation or ICU stay).3 The 2018 PAD, Immobility and Sleep (PADIS) guidelines make a graded conditional recommendation that light (vs deep) sedation, should be used, regardless of sedative choice, in critically ill, mechanically ventilated adults.1 The PADIS panel relied on evidence from eight randomised controlled trials (RCTs), published prior to October 2015, where light versus deep sedation was defined a priori and evaluated ≥4 times daily.1 Studies solely evaluating an SAT were excluded as this approach often results in light sedation at only a single time point during the 24-hour day.1 Results from RCTs were prioritised over cohort studies. Four RCTs compared a light (vs deep) sedation approach using the same sedative regimen. The other four RCTs compared a light (vs deep) approach where the light group either received a no (or ‘as needed’) sedation approach (n=2) or dexmedetomidine (n=2). Two RCTs implemented light sedation intervention for …