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Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort.

Abstract：

OBJECTIVES:We sought to study the association between sedation status, medications (benzodiazepines, opioids, and antipsychotics), and clinical outcomes in a resource-limited setting. DESIGN:A longitudinal study of critically ill participants on mechanical ventilation. SETTING:Five intensive care units (ICUs) in four public hospitals in Lima, Peru. PATIENTS:One thousand six hundred fifty-seven critically ill participants were assessed daily for sedation status during 28 days and vital status by day 90. RESULTS:After excluding data of participants without a Richmond Agitation Sedation Scale score and without sedation, we followed 1338 (81%) participants longitudinally for 18,645 ICU days. Deep sedation was present in 98% of participants at some point of the study and in 12,942 ICU days. Deep sedation was associated with higher mortality (interquartile odds ratio (OR) = 5.42, 4.23-6.95; p < 0.001) and a significant decrease in ventilator (- 7.27; p < 0.001), ICU (- 4.38; p < 0.001), and hospital (- 7.00; p < 0.001) free days. Agitation was also associated with higher mortality (OR = 39.9, 6.53-243, p < 0.001). The most commonly used sedatives were opioids and benzodiazepines (9259 and 8453 patient days respectively), and the latter were associated with a 41% higher mortality in participants with a higher cumulative dose (75th vs 25th percentile, interquartile OR = 1.41, 1.12-1.77; p < 0.01). The overall cumulative dose of benzodiazepines and opioids was high, 774.5 mg and 16.8 g, respectively, by day 7 and by day 28; these doses approximately doubled. Haloperidol was only used in 3% of ICU days; however, the use of it was associated with a 70% lower mortality (interquartile OR = 0.3, 0.22-0.44, p < 0.001). CONCLUSIONS:Deep sedation, agitation, and cumulative dose of benzodiazepines were all independently associated with higher 90-day mortality. Additionally, deep sedation was associated with less ventilator-, ICU-, and hospital-free days. In contrast, haloperidol was associated with lower mortality in our study.

journal_name

Crit Care

journal_title

Critical care (London, England)

authors

Aragón RE,Proaño A,Mongilardi N,de Ferrari A,Herrera P,Roldan R,Paz E,Jaymez AA,Chirinos E,Portugal J,Quispe R,Brower RG,Checkley W

doi

10.1186/s13054-019-2394-9

subject

Has Abstract

pub_date

2019-04-17 00:00:00

pages

130

issue

eissn

1364-8535

issn

1466-609X

pii

10.1186/s13054-019-2394-9

journal_volume

pub_type

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Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort.