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

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...

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Published inCritical care (London, England) Vol. 18; no. 4; p. R156
Main Authors Tanaka, Lilian Maria Sobreira, Azevedo, Luciano Cesar Pontes, Park, Marcelo, Schettino, Guilherme, Nassar, Antonio Paulo, Réa-Neto, Alvaro, Tannous, Luana, de Souza-Dantas, Vicente Ces, Torelly, André, Lisboa, Thiago, Piras, Claudio, Carvalho, Frederico Bruzzi, Maia, Marcelo de Oliveira, Giannini, Fabio Poianas, Machado, Flavia Ribeiro, Dal-Pizzol, Felipe, de Carvalho, Alexandre Guilherme Ribeiro, dos Santos, Ronaldo Batista, Tierno, Paulo Fernando Guimarães Morando Marzocchi, Soares, Marcio, Salluh, Jorge Ibrain Figueira
Format Journal Article
LanguageEnglish
Published England BioMed Central Ltd 21.07.2014
BioMed Central
Subjects
Acute respiratory distress syndrome
Adult
Aged
Cohort Studies
Comorbidity
Complications and side effects
Deep Sedation - methods
Deep Sedation - mortality
Deep Sedation - trends
Development and progression
Female
Hospital Mortality - trends
Hospital patients
Humans
Intensive Care Units - trends
Male
Middle Aged
Patient outcomes
Prospective Studies
Respiration, Artificial - mortality
Respiration, Artificial - trends
Risk factors
Time Factors
Treatment Outcome
Brazil
United Kingdom
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Abstract 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). 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. 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. Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.
AbstractList INTRODUCTIONSedation 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). METHODSA 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. RESULTSA 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. CONCLUSIONSEarly deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.
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 PaO.sub.2/FiO.sub.2 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.
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). 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. 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 PaO.sub.2/FiO.sub.2 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. Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.
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). 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. 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. Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.
ArticleNumber R156
Audience Academic
Author Nassar, Antonio Paulo
Giannini, Fabio Poianas
Torelly, André
Réa-Neto, Alvaro
Maia, Marcelo de Oliveira
Tannous, Luana
Park, Marcelo
Azevedo, Luciano Cesar Pontes
de Souza-Dantas, Vicente Ces
Dal-Pizzol, Felipe
Machado, Flavia Ribeiro
Tierno, Paulo Fernando Guimarães Morando Marzocchi
Schettino, Guilherme
Lisboa, Thiago
de Carvalho, Alexandre Guilherme Ribeiro
Tanaka, Lilian Maria Sobreira
Soares, Marcio
dos Santos, Ronaldo Batista
Salluh, Jorge Ibrain Figueira
Piras, Claudio
Carvalho, Frederico Bruzzi
AuthorAffiliation 2 Research and Education Institute, Hospital Sírio-Libanês, Rua Cel. Nicolau dos Santos 69, São Paulo 01308-060, Brazil
3 ICU, Emergency Medicine Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Av. Eneas Carvalho Aguiar 255, São Paulo 05403-000, Brazil
6 ICU, Instituto Nacional de Câncer – Hospital do Câncer I, Praça Cruz Vermelha 23, Rio de Janeiro 20230-130, Brazil
13 ICU, Anesthesiology, Pain and Intensive Care Department, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715 6° andar, São Paulo 04024-900, Brazil
1 Hospital Copa D’Or, Rua Figueiredo de Magalhães 875, Rio de Janeiro 22031-010, Brazil
7 ICU, Hospital Pasteur, Av. Amaro Cavalcanti 495, Rio de Janeiro 20735-040, Brazil
12 ICU, Hospital São Luiz, Unidade Itaim, Rua Doutor Alceu de Campos Rodrigues 95, São Paulo 04544-000, Brazil
19 Postgraduate Program, Instituto Nacional de Câncer, 10° Andar, Praça Cruz Vermelha 23, Rio de Janeiro 20230-130, Brazil
4 ICU, Hospital São Camilo Pom
AuthorAffiliation_xml – name: 5 CEPETI – Centro de Estudos e Pesquisas em Terapia Intensiva, Rua Monte Castelo 366, Curitiba 82530-200, Brazil
– name: 6 ICU, Instituto Nacional de Câncer – Hospital do Câncer I, Praça Cruz Vermelha 23, Rio de Janeiro 20230-130, Brazil
– name: 18 IDOR – D’Or Institute for Research and Education, Rua Diniz Cordeiro 30, Rio de Janeiro 22281-100, Brazil
– name: 3 ICU, Emergency Medicine Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Av. Eneas Carvalho Aguiar 255, São Paulo 05403-000, Brazil
– name: 1 Hospital Copa D’Or, Rua Figueiredo de Magalhães 875, Rio de Janeiro 22031-010, Brazil
– name: 2 Research and Education Institute, Hospital Sírio-Libanês, Rua Cel. Nicolau dos Santos 69, São Paulo 01308-060, Brazil
– name: 13 ICU, Anesthesiology, Pain and Intensive Care Department, Universidade Federal de São Paulo, Rua Napoleão de Barros, 715 6° andar, São Paulo 04024-900, Brazil
– name: 9 ICU, Vitoria Apart Hospital, Rodovia BR-101 Norte, Km 2, 38 Boa Vista II, Serra, ES 29161-900, Brazil
– name: 14 ICU, Hospital São José Criciúma, Rua Coronel Pedro Benedet 630, Criciúma 88801-250, Brazil
– name: 17 ICU, Surgical Emergency Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Av. Eneas Carvalho Aguiar 255, São Paulo 05403-000, Brazil
– name: 19 Postgraduate Program, Instituto Nacional de Câncer, 10° Andar, Praça Cruz Vermelha 23, Rio de Janeiro 20230-130, Brazil
– name: 10 ICU, Hospital Mater Dei, Rua Gonçalves Dias 2700 (Bloco I), Belo Horizonte 30140-093, Brazil
– name: 12 ICU, Hospital São Luiz, Unidade Itaim, Rua Doutor Alceu de Campos Rodrigues 95, São Paulo 04544-000, Brazil
– name: 16 ICU, Hospital Universitário da Universidade de São Paulo, Av Prof. Lineu Prestes 2565 – Cidade Universitária, São Paulo 05508-000, Brazil
– name: 7 ICU, Hospital Pasteur, Av. Amaro Cavalcanti 495, Rio de Janeiro 20735-040, Brazil
– name: 15 ICU, UDI Hospital, Av Professor Carlos Cunha 2000, São Luis 65076-820, Brazil
– name: 11 ICU, Hospital Santa Luzia, SHLS 716 – Conjunto E, Brasília 70390-902, Brazil
– name: 4 ICU, Hospital São Camilo Pompeia, Av. Pompeia 1178, São Paulo 05022-000, Brazil
– name: 8 Rede Institucional de Pesquisa e Inovação em Medicina Intensiva (RIPIMI), Irmandade da Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias 285 – Centro Histórico, Porto Alegre 90020-090, Brazil
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/25047960$$D View this record in MEDLINE/PubMed
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ContentType Journal Article
Copyright COPYRIGHT 2014 BioMed Central Ltd.
Copyright © 2014 Tanaka et al.; licensee BioMed Central Ltd. 2014 Tanaka et al.; licensee BioMed Central Ltd.
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– notice: Copyright © 2014 Tanaka et al.; licensee BioMed Central Ltd. 2014 Tanaka et al.; licensee BioMed Central Ltd.
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Snippet Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early...
Introduction Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of...
INTRODUCTIONSedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of...
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StartPage R156
SubjectTerms Acute respiratory distress syndrome
Adult
Aged
Cohort Studies
Comorbidity
Complications and side effects
Deep Sedation - methods
Deep Sedation - mortality
Deep Sedation - trends
Development and progression
Female
Hospital Mortality - trends
Hospital patients
Humans
Intensive Care Units - trends
Male
Middle Aged
Patient outcomes
Prospective Studies
Respiration, Artificial - mortality
Respiration, Artificial - trends
Risk factors
Time Factors
Treatment Outcome
Title Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study
URI https://www.ncbi.nlm.nih.gov/pubmed/25047960
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https://pubmed.ncbi.nlm.nih.gov/PMC4223597
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