tetano
Editor, Senior Moderator
Crit Care
. 2022 Jun 15;26(1):179.
doi: 10.1186/s13054-022-04042-9.
A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study
Robert J Stephens[SUP] 1 [/SUP], Erin M Evans[SUP] 2 [/SUP], Michael J Pajor[SUP] 3 [/SUP], Ryan D Pappal[SUP] 4 [/SUP], Haley M Egan[SUP] 5 [/SUP], Max Wei[SUP] 5 [/SUP], Hunter Hayes[SUP] 5 [/SUP], Jason A Morris[SUP] 6 [/SUP], Nicholas Becker[SUP] 7 [/SUP], Brian W Roberts[SUP] 8 [/SUP], Marin H Kollef[SUP] 9 [/SUP], Nicholas M Mohr[SUP] 2 [/SUP], Brian M Fuller[SUP] 10 [/SUP]
Affiliations
Abstract
Background: Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes.
Study design and methods: Dual-center, retrospective cohort study conducted over 6 months (March-August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of - 3 to - 5 or Riker Sedation-Agitation Scale of 1-3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days.
Results: 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65-7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19.
Conclusions: The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach.
Keywords: COVID; Deep sedation; Emergency department; Mechanical ventilation.
. 2022 Jun 15;26(1):179.
doi: 10.1186/s13054-022-04042-9.
A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study
Robert J Stephens[SUP] 1 [/SUP], Erin M Evans[SUP] 2 [/SUP], Michael J Pajor[SUP] 3 [/SUP], Ryan D Pappal[SUP] 4 [/SUP], Haley M Egan[SUP] 5 [/SUP], Max Wei[SUP] 5 [/SUP], Hunter Hayes[SUP] 5 [/SUP], Jason A Morris[SUP] 6 [/SUP], Nicholas Becker[SUP] 7 [/SUP], Brian W Roberts[SUP] 8 [/SUP], Marin H Kollef[SUP] 9 [/SUP], Nicholas M Mohr[SUP] 2 [/SUP], Brian M Fuller[SUP] 10 [/SUP]
Affiliations
- PMID: 35705989
- DOI: 10.1186/s13054-022-04042-9
Abstract
Background: Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes.
Study design and methods: Dual-center, retrospective cohort study conducted over 6 months (March-August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of - 3 to - 5 or Riker Sedation-Agitation Scale of 1-3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days.
Results: 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65-7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19.
Conclusions: The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach.
Keywords: COVID; Deep sedation; Emergency department; Mechanical ventilation.