Sedating Drugs and Neuromuscular Blockade During Mechanical Ventilation

To the Editor. —One of the important points raised by Hansen-Flaschen et al¹ in their survey on the use of sedating drugs and neuromuscular blocking agents in patients requiring mechanical ventilation is the wide range of costs associated with these therapies. I believe consideration should be given to sublingual lorazepam as a potential means of continuous sedation in intubated patients with nonfunctioning gastrointestinal tracts.

The use of sublingual lorazepam has not been formally studied in the acute care setting. Support for investigation of the use of this drug should be encouraged by pharmacokinetic studies of commercially available oral formulations that indicate complete absorption with peak levels within 1 to 2 hours.^2,3 In addition, a double-blind, placebo-controlled trial has clearly demonstrated the clinical use of sublingual lorazepam as a sedative in the preoperative setting.⁴ Lastly, the potential for substantial cost savings is impressive: one 2-mg tablet of lorazepam given