Is there a role for awakening the critically ill patient?

Is there a role for Sugammadex to awaken the patient with a failing airway? Perhaps, but not in the critically ill. Here are 3 reasons to keep'em sleepin: 1. These patients are not going to awaken to a physiologically normal premorbid state and sit up to say thanks. However sick they were prior to intubation they will be sicker now and not able to independently oxygenate or ventilate. 2. An awakening patient will not be your friend when you are encountering difficulty. BMV, DL, SGA placement and performing an ESA will all be easier to do in the controlled setting of a paralyzed patient. 3. We keep on looking for ways to avoid what needs to be done. Can't Intubate, can't oxygenate mandates moving to the front of the neck not drawing up another drug. NAP4 and other data sets have told us that the biggest delay in performing an ESA is making the decision.

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