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.

journal_name

Crit Care

authors

Tanaka LM,Azevedo LC,Park M,Schettino G,Nassar AP,Réa-Neto A,Tannous L,de Souza-Dantas VC,Torelly A,Lisboa T,Piras C,Carvalho FB,Maia Mde O,Giannini FP,Machado FR,Dal-Pizzol F,de Carvalho AG,dos Santos RB,Tierno PF,

doi

10.1186/cc13995

subject

Has Abstract

pub_date

2014-07-21 00:00:00

pages

R156

issue

4

eissn

1364-8535

issn

1466-609X

pii

cc13995

journal_volume

18

pub_type

杂志文章,多中心研究
  • Corticosteroid therapy in refractory shock following cardiac arrest: a randomized, double-blind, placebo-controlled, trial.

    abstract:BACKGROUND:The purpose of this study was to determine whether the provision of corticosteroids improves time to shock reversal and outcomes in patients with post-cardiac arrest shock. METHODS:We conducted a randomized, double-blind trial of post-cardiac arrest patients in shock, defined as vasopressor support for a mi...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/s13054-016-1257-x

    authors: Donnino MW,Andersen LW,Berg KM,Chase M,Sherwin R,Smithline H,Carney E,Ngo L,Patel PV,Liu X,Cutlip D,Zimetbaum P,Cocchi MN,Collaborating Authors from the Beth Israel Deaconess Medical Center’s Center for Resuscitation Science Re

    更新日期:2016-04-03 00:00:00

  • Pulse high-volume haemofiltration for treatment of severe sepsis: effects on hemodynamics and survival.

    abstract:INTRODUCTION:Severe sepsis is the leading cause of mortality in critically ill patients. Abnormal concentrations of inflammatory mediators appear to be involved in the pathogenesis of sepsis. Based on the humoral theory of sepsis, a potential therapeutic approach involves high-volume haemofiltration (HVHF), which has e...

    journal_title:Critical care (London, England)

    pub_type: 临床试验,杂志文章

    doi:10.1186/cc3529

    authors: Ratanarat R,Brendolan A,Piccinni P,Dan M,Salvatori G,Ricci Z,Ronco C

    更新日期:2005-08-01 00:00:00

  • Impact of antibacterials on subsequent resistance and clinical outcomes in adult patients with viral pneumonia: an opportunity for stewardship.

    abstract:INTRODUCTION:Respiratory viruses are increasingly recognized as significant etiologies of pneumonia among hospitalized patients. Advanced technologies using multiplex molecular assays and polymerase-chain reaction increase the ability to identify viral pathogens and may ultimately impact antibacterial use. METHOD:This...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-015-1120-5

    authors: Crotty MP,Meyers S,Hampton N,Bledsoe S,Ritchie DJ,Buller RS,Storch GA,Kollef MH,Micek ST

    更新日期:2015-11-18 00:00:00

  • Association between time of discharge from ICU and hospital mortality: a systematic review and meta-analysis.

    abstract:BACKGROUND:Epidemiological studies have provided inconsistent results on whether intensive care unit (ICU) discharge at night and on weekends is associated with an increased risk of mortality. This systematic review and meta-analysis aimed to determine whether ICU discharge time was associated with hospital mortality. ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,meta分析,评审

    doi:10.1186/s13054-016-1569-x

    authors: Yang S,Wang Z,Liu Z,Wang J,Ma L

    更新日期:2016-12-01 00:00:00

  • In vitro norepinephrine significantly activates isolated platelets from healthy volunteers and critically ill patients following severe traumatic brain injury.

    abstract:INTRODUCTION:Norepinephrine, regularly used to increase systemic arterial blood pressure and thus improve cerebral perfusion following severe traumatic brain injury (TBI), may activate platelets. This, in turn, could promote microthrombosis formation and induce additional brain damage. METHODS:The objective of this st...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc6931

    authors: Tschuor C,Asmis LM,Lenzlinger PM,Tanner M,Härter L,Keel M,Stocker R,Stover JF

    更新日期:2008-01-01 00:00:00

  • The World Trade Center attack. Lessons for all aspects of health care.

    abstract::The attack on the World Trade Center had the potential to overwhelm New York's health services. Sadly, however, the predicted thousands of treatable patients failed to materialize. Horror and sadness has now been replaced by anger, fear, and the determination to be better prepared next time. This determination not onl...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/cc1053

    authors: Tamber PS,Vincent JL

    更新日期:2001-12-01 00:00:00

  • Utility of neuron-specific enolase in traumatic brain injury; relations to S100B levels, outcome, and extracranial injury severity.

    abstract:BACKGROUND:In order to improve assessment and outcome prediction in patients suffering from traumatic brain injury (TBI), cerebral protein levels in serum have been suggested as biomarkers of injury. However, despite much investigation, biomarkers have yet to reach broad clinical utility in TBI. This study is a 9-year ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/s13054-016-1450-y

    authors: Thelin EP,Jeppsson E,Frostell A,Svensson M,Mondello S,Bellander BM,Nelson DW

    更新日期:2016-09-08 00:00:00

  • Clinical review: Intensive care follow-up--what has it told us?

    abstract::The majority of intensive care practitioners, until comparatively recently, was content to discharge surviving patients to the care of referring primary specialty colleagues who would undertake subsequent inpatient and outpatient care. With the exception of mortality statistics from clinical studies, the practitioners...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/cc1532

    authors: Broomhead LR,Brett SJ

    更新日期:2002-10-01 00:00:00

  • How the relationships between general practitioners and intensivists can be improved: the general practitioners' point of view.

    abstract:INTRODUCTION:The present study assessed the opinion of general practitioners (GPs) concerning their relationships with intensivists. METHODS:An anonymous questionnaire was mailed to 7,239 GPs. GPs were asked about their professional activities, postgraduate intensive care unit (ICU) training, the rate of patient admit...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc9061

    authors: Etesse B,Jaber S,Mura T,Leone M,Constantin JM,Michelet P,Zoric L,Capdevila X,Malavielle F,Allaouchiche B,Orban JC,Fabbro-Peray P,Lefrant JY,AzuRéa Group.

    更新日期:2010-01-01 00:00:00

  • Recent evolution of renal replacement therapy in the critically ill patient.

    abstract::The epidemiology of severe acute renal failure has dramatically changed in the past decade. Its leading cause is sepsis and the syndrome develops mostly in the intensive care unit as part of multiple organ dysfunction syndrome. After the significant improvements obtained from the mid 1970s to the mid 1990s, the past d...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/cc4843

    authors: Ronco C

    更新日期:2006-02-01 00:00:00

  • Choosing wisely - when to mend a broken heart with ECMO?

    abstract::Refractory cardiac shock in the cardiac surgical intensive care unit confers significant morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) has become a common intervention for refractory cardiogenic shock when other therapies have failed. However, it is difficult to predict who will benefit from this...

    journal_title:Critical care (London, England)

    pub_type: 评论,杂志文章

    doi:10.1186/cc13736

    authors: Stephens R,Fan E

    更新日期:2014-02-20 00:00:00

  • Systemic endotoxin activity correlates with clot formation: an observational study in patients with early systemic inflammation and sepsis.

    abstract:INTRODUCTION:Inflammation and coagulation are closely linked, and both can be triggered by endotoxin. Thrombelastometry and impedance aggregometry are of diagnostic and predictive value in critically ill patients. In this observational study we investigated the correlation of endotoxin activity with thrombelasometric a...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc12892

    authors: Koch A,Meesters MI,Scheller B,Boer C,Zacharowski K

    更新日期:2013-09-11 00:00:00

  • Cost effectiveness of antimicrobial catheters in the intensive care unit: addressing uncertainty in the decision.

    abstract:INTRODUCTION:Some types of antimicrobial-coated central venous catheters (A-CVC) have been shown to be cost effective in preventing catheter-related bloodstream infection (CR-BSI). However, not all types have been evaluated, and there are concerns over the quality and usefulness of these earlier studies. There is uncer...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc7744

    authors: Halton KA,Cook DA,Whitby M,Paterson DL,Graves N

    更新日期:2009-01-01 00:00:00

  • Changes in pulse pressure variability during cardiac resynchronization therapy in mechanically ventilated patients.

    abstract:INTRODUCTION:The respiratory variation in pulse pressure (PP) has been established as a dynamic variable of cardiac preload which indicates fluid responsiveness in mechanically ventilated patients. The impact of acute changes in cardiac performance on respiratory fluctuations in PP has not been evaluated until now. We ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc5779

    authors: Keyl C,Stockinger J,Laule S,Staier K,Schiebeling-Römer J,Wiesenack C

    更新日期:2007-01-01 00:00:00

  • Prediction of mortality in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation: a prospective observational study.

    abstract:INTRODUCTION:Veno-venous extracorporeal membrane oxygenation (vvECMO) can be a life-saving therapy in patients with severe acute lung failure refractory to conventional therapy. Nevertheless, vvECMO is a procedure associated with high costs and resource utilization. The aim of this study was to assess published models ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc13824

    authors: Enger T,Philipp A,Videm V,Lubnow M,Wahba A,Fischer M,Schmid C,Bein T,Müller T

    更新日期:2014-04-09 00:00:00

  • 'One patient amongst many': a qualitative analysis of intensive care unit patients' experiences of transferring to the general ward.

    abstract:INTRODUCTION:Many patients experience 'relocation stress' when they are transferred from an intensive care unit (ICU) to step-down (high dependency) or general ward care, and much has been written about the psychological causes. This qualitative analysis of in-depth, narrative interviews with former ICU patients explor...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc6795

    authors: Field K,Prinjha S,Rowan K

    更新日期:2008-01-01 00:00:00

  • Mild hypothermia after near drowning in twin toddlers.

    abstract:INTRODUCTION:We report a case of twin toddlers who both suffered near drowning but with different post-trauma treatment and course, and different neurological outcomes. METHODS AND RESULTS:Two twin toddlers (a boy and girl, aged 2 years and 3 months) suffered hypothermic near drowning with protracted cardiac arrest an...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc2926

    authors: Hein OV,Triltsch A,von Buch C,Kox WJ,Spies C

    更新日期:2004-10-01 00:00:00

  • Limb ischemia in peripheral veno-arterial extracorporeal membrane oxygenation: a narrative review of incidence, prevention, monitoring, and treatment.

    abstract::Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an increasingly adopted life-saving mechanical circulatory support for a number of potentially reversible or treatable cardiac diseases. It is also started as a bridge-to-transplantation/ventricular assist device in the case of unrecoverable cardiac or ca...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/s13054-019-2541-3

    authors: Bonicolini E,Martucci G,Simons J,Raffa GM,Spina C,Coco VL,Arcadipane A,Pilato M,Lorusso R

    更新日期:2019-07-30 00:00:00

  • Effect of glomerular filtration rate impairment on diagnostic performance of neutrophil gelatinase-associated lipocalin and B-type natriuretic peptide as markers of acute cardiac and renal failure in chronic kidney disease patients.

    abstract:INTRODUCTION:Cardio-renal syndromes are characterized by the impairment of cardiac and renal functions. Plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL), and plasma B-type natriuretic peptide (BNP) are markers of acute kidney injury (AKI) and heart failure (HF), respectively. METHODS:GFR (99mTc-DTP...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc13752

    authors: Donadio C

    更新日期:2014-02-28 00:00:00

  • Hyperbilirubinaemia after major thoracic surgery: comparison between open-heart surgery and oesophagectomy.

    abstract:BACKGROUND:Hyperbilirubinaemia is a common occurrence in patients who are admitted to intensive care units (ICUs) after major surgery, and it is associated with high mortality. We investigated the incidence of hyperbilirubinaemia after two major types of thoracic surgery: open-heart surgery and oesophagectomy. In order...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc691

    authors: Hosotsubo KK,Nishimura M,Nishimura S

    更新日期:2000-01-01 00:00:00

  • Bench-to-bedside review: carbon dioxide.

    abstract::Carbon dioxide is a waste product of aerobic cellular respiration in all aerobic life forms. PaCO2 represents the balance between the carbon dioxide produced and that eliminated. Hypocapnia remains a common - and generally underappreciated - component of many disease states, including early asthma, high-altitude pulmo...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/cc8926

    authors: Curley G,Laffey JG,Kavanagh BP

    更新日期:2010-01-01 00:00:00

  • Bench-to-bedside review: circulating microparticles--a new player in sepsis?

    abstract::In sepsis, inflammation and thrombosis are both the cause and the result of interactions between circulating (for example, leukocytes and platelets), endothelial and smooth muscle cells. Microparticles are proinflammatory and procoagulant fragments originating from plasma membrane generated after cellular activation a...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/cc9231

    authors: Meziani F,Delabranche X,Asfar P,Toti F

    更新日期:2010-01-01 00:00:00

  • Year in review 2013: Critical Care--sepsis.

    abstract::This review presents key publications from the research field of sepsis published in Critical Care and other relevant journals during 2013. The results of these experimental studies and clinical trials are discussed in the context of current scientific and clinical background. The discussion highlights and summarises ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/s13054-014-0578-x

    authors: de Montmollin E,Annane D

    更新日期:2014-10-15 00:00:00

  • A prospective observational study of the relationship of critical illness associated hyperglycaemia in medical ICU patients and subsequent development of type 2 diabetes.

    abstract:INTRODUCTION:Critical illness is commonly complicated by hyperglycaemia caused by mediators of stress and inflammation. Severity of disease is the main risk factor for development of hyperglycaemia, but not all severely ill develop hyperglycemia and some do even in mild disease. We hypothesised that acute disease only ...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc9101

    authors: Gornik I,Vujaklija-Brajkovic A,Renar IP,Gasparovic V

    更新日期:2010-01-01 00:00:00

  • Vasoplegic syndrome following cardiothoracic surgery-review of pathophysiology and update of treatment options.

    abstract::Vasoplegic syndrome is a common occurrence following cardiothoracic surgery and is characterized as a high-output shock state with poor systemic vascular resistance. The pathophysiology is complex and includes dysregulation of vasodilatory and vasoconstrictive properties of smooth vascular muscle cells. Specific bypas...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/s13054-020-2743-8

    authors: Busse LW,Barker N,Petersen C

    更新日期:2020-02-04 00:00:00

  • Is acute respiratory distress syndrome an iatrogenic disease?

    abstract::In this month's issue of Critical Care, Determann and colleagues report the results of a randomized controlled trial comparing the effects of mechanical ventilation (MV) with two tidal volumes (6 versus 10 ml/kg predicted body weight) on cytokine levels in lung lavage fluid and plasma as a surrogate for early identifi...

    journal_title:Critical care (London, England)

    pub_type: 社论

    doi:10.1186/cc8842

    authors: Villar J,Slutsky AS

    更新日期:2010-01-01 00:00:00

  • Decompressive craniectomy for acute ischemic stroke.

    abstract::Malignant stroke occurs in a subgroup of patients suffering from ischemic cerebral infarction and is characterized by neurological deterioration due to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique aiming to open the "closed box" repres...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/s13054-019-2490-x

    authors: Beez T,Munoz-Bendix C,Steiger HJ,Beseoglu K

    更新日期:2019-06-07 00:00:00

  • "Awake" extracorporeal membrane oxygenation (ECMO): pathophysiology, technical considerations, and clinical pioneering.

    abstract::Venovenous extracorporeal membrane oxygenation (vv-ECMO) has been classically employed as a rescue therapy for patients with respiratory failure not treatable with conventional mechanical ventilation alone. In recent years, however, the timing of ECMO initiation has been readdressed and ECMO is often started earlier i...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,评审

    doi:10.1186/s13054-016-1329-y

    authors: Langer T,Santini A,Bottino N,Crotti S,Batchinsky AI,Pesenti A,Gattinoni L

    更新日期:2016-06-30 00:00:00

  • Inter-hospital transport of critically ill patients; expect surprises.

    abstract:INTRODUCTION:Inter-hospital transport of critically ill patients is increasing. When performed by specialized retrieval teams there are less adverse events compared to transport by ambulance. These transports are performed with technical equipment also used in an Intensive Care Unit (ICU). As a consequence technical pr...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章

    doi:10.1186/cc11191

    authors: Droogh JM,Smit M,Hut J,de Vos R,Ligtenberg JJ,Zijlstra JG

    更新日期:2012-02-12 00:00:00

  • Ventilator-associated pneumonia using a heated humidifier or a heat and moisture exchanger: a randomized controlled trial [ISRCTN88724583].

    abstract:INTRODUCTION:Some guidelines to prevent ventilator-associated pneumonia (VAP) do not establish a recommendation for the preferential use of either heat and moisture exchangers (HMEs) or heated humidifiers (HHs), while other guidelines clearly advocate the use of HMEs. The aim of this study was to determine the incidenc...

    journal_title:Critical care (London, England)

    pub_type: 杂志文章,随机对照试验

    doi:10.1186/cc5009

    authors: Lorente L,Lecuona M,Jiménez A,Mora ML,Sierra A

    更新日期:2006-01-01 00:00:00