As well as ensuring sufficient pain relief and anxiolysis, analgosedation is used to adapt the patient to mechanical ventilation [52, 56]. The level of analgosedation required during controlled mechanical ventilation is equivalent to a Ramsay score between 4 and 5, that is a deeply sedated patient unable to respond when spoken to and having no sensation of pain. During partial ventilatory support a Ramsay score between 2 and 3 can be targeted, i.e., an awake, responsive and cooperative patient [56]. In a retrospective study in about 600 heart surgery patients, and in a prospective investigation in patients with multiple trauma, maintaining spontaneous breathing with APRV/BiPAP lead to significantly lower consumption of analgesics and sedatives compared to initial use of controlled mechanical ventilation followed by weaning with partial ventilatory support [33,57].Obviouslyalargepart of analgosedation is used exclusively to adapt patients to controlled mechanical ventilation. The higher doses of analgesics and sedatives used to adapt patients to controlled mechanical ventilation require higher doses of vasopressors and positive inotrops to maintain cardiovascular function stable [33]. Both from a medical and from an economic point of view it would therefore appear sensible to provide mechanical support with spontaneous breathing.

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