Early deep sedation is associated with decreased in-hospital and two-year follow-up survival

Felix Balzer, Björn Weiß, Oliver Kumpf, Sascha Treskatsch, Claudia Spies, Klaus-Dieter Wernecke, Alexander Krannich, Marc Kastrup, Felix Balzer, Björn Weiß, Oliver Kumpf, Sascha Treskatsch, Claudia Spies, Klaus-Dieter Wernecke, Alexander Krannich, Marc Kastrup

Abstract

Introduction: There is increasing evidence that deep sedation is detrimental to critically ill patients. The aim of this study was to examine effects of deep sedation during the early period after ICU admission on short- and long-term survival.

Methods: In this observational, matched-pair analysis, patients receiving mechanical ventilation that were admitted to ICUs of a tertiary university hospital in six consecutive years were grouped as either lightly or deeply sedated within the first 48 hours after ICU admission. The Richmond Agitation-Sedation Score (RASS) was used to assess sedation depth (light sedation: -2 to 0; deep: -3 or below). Multivariate Cox regression was conducted to investigate the impact of early deep sedation within the first 48 hours of admission on in-hospital and two-year follow-up survival.

Results: In total, 1,884 patients met inclusion criteria out of which 27.2% (n = 513) were deeply sedated. Deeply sedated patients had longer ventilation times, increased length of stay and higher rates of mortality. Early deep sedation was associated with a hazard ratio of 1.661 (95% CI: 1.074 to 2.567; P = 0.022) for in-hospital survival and 1.866 (95% CI: 1.351 to 2.576; P < 0.001) for two-year follow-up survival.

Conclusions: Early deep sedation during the first 48 hours of intensive care treatment was associated with decreased in-hospital and two-year follow-up survival. Since early deep sedation is a modifiable risk factor, this data shows an urgent need for prospective clinical trials focusing on light sedation in the early phase of ICU treatment.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) diagram.
Figure 2
Figure 2
Kaplan-Meier curves for time to extubation (hours from admission to the ICU until extubation of the patient) in matched cohort. NDS, not deeply sedated; DS, deeply sedated.
Figure 3
Figure 3
Kaplan-Meier curve for in-hospital survival (all causes) in matched cohort. NDS, not deeply sedated; DS, deeply sedated.
Figure 4
Figure 4
Kaplan-Meier curves for the two-year survival in matched cohort. NDS, not deeply sedated; DS, deeply sedated.

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Source: PubMed

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