We've explored the history of sedation in ICU, the impact of daily awakening trials, and the risks of deep sedation. In this episode, we focus on how to embed that evidence into practice — through the use of structured sedation protocols.

Protocols don't just provide guidance; they transform everyday ICU culture, reduce variation in care, and improve outcomes. But implementing them isn't always easy. This episode explores the why, what, and how of sedation protocols — and the cultural shift they demand.

What You'll Learn in This Episode

• 🏥 Why protocols were needed: how variation in sedation practices led to prolonged ICU stays and unpredictable patient journeys.

• 🧪 What makes up a sedation protocol: RASS targets, daily sedation holds, nurse-led titration, and structured decision-making.

• 📊 Evidence that protocols work: from Brook's 2000 trial to the PAD guidelines and beyond.

• 🔄 Barriers to implementation: fear of agitation, staff training gaps, inconsistent documentation, and cultural resistance.

• 🛠️ Real-world examples: quality improvement projects that boosted compliance and shortened ventilation times.

• 🎯 Protocols as safety nets: creating safe, evidence-informed defaults while leaving room for clinical judgment.

Key References

• Brook AD, et al. JAMA. 2000.

• Martin J, et al. Intensive Care Med. 2001.

• Mehta S, et al. Lancet. 2008.

• Barr J, et al. Crit Care Med. 2013 (PAD Guidelines).

• Schmidt GA, et al. ATS/Chest Guidelines. 2016.

• Mehta S, et al. Crit Care Med. 2012.

• Ferraioli S, et al. BMJ Open Qual. 2019.

Takeaway Message

Sedation protocols are not about rigid rules — they're about shared standards, safety, and empowerment. They help us move from practice variation to consistent, evidence-based care that improves both efficiency and patient outcomes.

If your ICU already uses a protocol, engage with it fully. If not, perhaps it's time to start the conversation