Letter to the Editor: Impact of the intensivist at the bedside - the case of rational use of benzodiazepines.

The detrimental effects associated with prolonged benzodiazepine infusion have long been recognized, and precipitated a transformation in the management of sedation and analgesia in critically ill patients. This transformation emphasizes the need to reduce the continuous use of benzodiazepines. Achieving an appropriate sedo-analgesia target tailored to the patient's context requires clinical staff to possess knowledge and considerable experience in this management. The study published in World Journal of Critical Care Medicine by Nestoiter et al exemplified this scenario. The authors identified an association between the continuous use of midazolam and the absence of a critical care team managing patients at the bedside. The use of continuous midazolam, as an indicator of good clinical practice, was associated with unfavorable clinical outcomes, such as increased days in coma and delirium. These results reinforce the fact that effective management of sedation and analgesia is a critical area where the fundamental role of the intensivist in the care of critically ill patients is evident. These findings should not be interpreted in isolation but rather within a set of organizational aspects that characterize a high-performing intensive care unit, such as an adequate patient-to-nurse ratio, the presence of an intensivist-led team, and the development of clinical protocols in sedation and analgesia management.