Critical Care (Apr 2019)

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

  • Romina E. Aragón,
  • Alvaro Proaño,
  • Nicole Mongilardi,
  • Aldo de Ferrari,
  • Phabiola Herrera,
  • Rollin Roldan,
  • Enrique Paz,
  • Amador A. Jaymez,
  • Eduardo Chirinos,
  • Jose Portugal,
  • Rocio Quispe,
  • Roy G. Brower,
  • William Checkley

DOI
https://doi.org/10.1186/s13054-019-2394-9
Journal volume & issue
Vol. 23, no. 1
pp. 1 – 9

Abstract

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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.

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