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Introduction
In critically ill mechanically ventilated patients, minimization of sedation improves patient outcomes by reducing duration of mechanical ventilation and intensive care unit (ICU) length of stay [1] . Nurse-directed protocolized sedation and daily interruption (DI) of sedation are common sedation minimization strategies endorsed by current practice guidelines [1-5] . Although both strategies have been shown to be safe, clinical uptake is variable, with approximately 60% of clinicians using sedation protocols and less than 40% using DI [6,7] . Previously reported perceived barriers to the use of a sedation protocol include lack of a clear physician directive for use, nursing disinclination, and situations where the ICU clinician would like more control of sedation than a protocol permits [8] .
Several studies report clinician perspectives of DI [8-11] . In a study that evaluated willingness to interrupt sedation, nurses reported that they were less likely to use DI for patients who had a higher severity of illness or were unstable (eg, requiring high fraction of inspired oxygen or vasopressors) or for those that required deep sedation and high sedative infusion rates [9] . In an implementation trial of DI combined with a spontaneous breathing trial, DI was performed on only 44% of days, with the lowest compliance on the first day of mechanical ventilation, on days when a neuromuscular blocker was administered, and on days when the fraction of inspired oxygen exceeded 60% [11] . Study authors concluded that nurses were hesitant to perform DI for patients perceived as unlikely to be extubated and that they preferred to limit rather than interrupt sedation. Despite these concerns, a recent systematic review reports that DI has been evaluated in 9 randomized controlled trials including 1282 patients with no evidence of increased risk of adverse events compared with protocolized or usual care sedation [12] .
SLEAP, a prospective, multicenter trial that randomized critically ill mechanically ventilated patients to a sedation protocol alone or to a sedation protocol plus DI, found no differences in ventilation duration, lengths of ICU and hospital stay, or accidental device removal [5] . The DI group received higher doses of benzodiazepines and opioids, and nurses reported higher perceived workload compared with the control group [5] . Using a questionnaire administered daily in 5 centers,...