Nedel W. Letter to the Editor: Impact of the intensivist at the bedside - the case of rational use of benzodiazepines. World J Crit Care Med 2026; 15(2): 116049 [DOI: 10.5492/wjccm.v15.i2.116049]
Corresponding Author of This Article
Wagner Nedel, MD, PhD, Assistant Professor, Department of Intensive Care Unit, Conceição Hospital Group, Francisco Trein 596, Segundo Andar, Porto Alegre 91350200, Brazil. wagnernedel@gmail.com
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Critical Care Medicine
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Correspondence
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Nedel W. Letter to the Editor: Impact of the intensivist at the bedside - the case of rational use of benzodiazepines. World J Crit Care Med 2026; 15(2): 116049 [DOI: 10.5492/wjccm.v15.i2.116049]
World J Crit Care Med. Jun 9, 2026; 15(2): 116049 Published online Jun 9, 2026. doi: 10.5492/wjccm.v15.i2.116049
Letter to the Editor: Impact of the intensivist at the bedside - the case of rational use of benzodiazepines
Wagner Nedel
Wagner Nedel, Department of Intensive Care Unit, Conceição Hospital Group, Porto Alegre 91350200, Brazil
Author contributions: Nedel W contributed to manuscript conceptualization and writing.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Wagner Nedel, MD, PhD, Assistant Professor, Department of Intensive Care Unit, Conceição Hospital Group, Francisco Trein 596, Segundo Andar, Porto Alegre 91350200, Brazil. wagnernedel@gmail.com
Received: November 2, 2025 Revised: December 19, 2025 Accepted: January 27, 2026 Published online: June 9, 2026 Processing time: 201 Days and 18.6 Hours
Abstract
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.
Core Tip: Continuous infusion of benzodiazepines, such as midazolam, is associated with worse outcomes in critically ill patients. This study indicates that management by a dedicated critical care team (CCT) significantly reduces the use of midazolam, thereby reducing the risk of delirium and coma. CCT is especially effective when combined with organizational strengths, such as low patient-to-nurse ratios. Ultimately, a “virtuous circle” of care, in which CCT is an important player, is essential for improving outcomes through precise patient-centered sedo-analgesia.
