Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study.

Abstract

INTRODUCTION:

Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV).

METHODS:

A secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality.

RESULTS:

A total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P = 0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P = 0.001) despite similar PaO2/FiO2 ratios and acute respiratory distress syndrome (ARDS) severity. In a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% CI, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; CI 95%, 1.00 to 1.04), severe ARDS (OR 1.44; CI 95%, 1.09 to 1.91) and deep sedation (OR 2.36; CI 95%, 1.31 to 4.25) were independently associated with increased hospital mortality.

CONCLUSIONS:

Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.

• Authors: Lilian Maria Sobreira Tanaka, Luciano Cesar Pontes Azevedo, Marcelo Park, Guilherme Schettino, Antonio Paulo Nassar, Alvaro Réa-Neto, Luana Tannous, Vicente Ces de Souza-Dantas, André Torelly, Thiago Lisboa, Claudio Piras, Frederico Bruzzi Carvalho, Marcelo de Oliveira Maia, Fabio Poianas Giannini, Flavia Ribeiro Machado, Felipe Dal-Pizzol, Alexandre Guilherme Ribeiro de Carvalho, Ronaldo Batista dos Santos, Paulo Fernando Guimarães Morando Marzocchi Tierno, Marcio Soares, Jorge Ibrain Figueira Salluh, ERICC study investigators
• Journal: Critical care (London, England) (Crit Care) Vol. 18 Issue 4 Pg. R156 (Jul 21 2014) ISSN: 1466-609X [Electronic] England
• PMID: 25047960 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Cohort Studies
• Deep Sedation (methods, mortality, trends)
• Female
• Hospital Mortality (trends)
• Humans
• Intensive Care Units (trends)
• Male
• Middle Aged
• Prospective Studies
• Respiration, Artificial (mortality, trends)
• Time Factors
• Treatment Outcome