Early Sedation Depth and Clinical Outcomes in Mechanically Ventilated Patients in a Hospital: Retrospective Cohort Study
sum mary: Purpose: This study aimed to identify the early sedation depth in the first 48 hours of mechanical ventilation and its relationship to clinical outcomes to promote the transition to light sedation. Methods: This retrospective single-center cohort study was conducted in two medical intensi...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-02-01
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| Series: | Asian Nursing Research |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1976131722000718 |
| _version_ | 1811161833103425536 |
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| author | Jeong Mi Hwang Su Jung Choi |
| author_facet | Jeong Mi Hwang Su Jung Choi |
| author_sort | Jeong Mi Hwang |
| collection | DOAJ |
| description | sum mary: Purpose: This study aimed to identify the early sedation depth in the first 48 hours of mechanical ventilation and its relationship to clinical outcomes to promote the transition to light sedation. Methods: This retrospective single-center cohort study was conducted in two medical intensive care units (MICUs) at a general tertiary hospital, using a standardized sedation protocol. To investigate the early sedation depth, the Sedation Index was used, which can indicate changes over the first 48 hours. Patients were divided into three groups based on tertiles of Sedation Index. The primary outcome was mortality at 30, 90, and 180 days. The secondary outcomes included length of stay in the ICU and ventilator-free days. Kaplan-Meier analysis and multivariable Cox regression were conducted to compare factors influencing mortality. Results: This study included 394 patients. The deepest sedation group showed more severe illness, delirium, and deeper sedation at admission (p < .001). The survival curve decreased as sedation increased, even within the light sedation levels. In the deepest sedation group, 30-day mortality (hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.33–3.34), 90-day mortality (HR 2.00, 95% CI 1.31–3.06), and 180-day mortality (HR 1.77, 95% CI 1.17–2.67) increased. The length of stay in the ICU and ventilator-free days did not show statistical differences. Conclusions: These results indicate that early deep sedation is a modifiable factor that can potentially affect mortality. The protocol for inducing the transition into light sedation must comply with recommendations to improve clinical outcomes. |
| first_indexed | 2024-04-10T06:21:34Z |
| format | Article |
| id | doaj.art-56ed01e6c9464ac69a3853ad2dbe8541 |
| institution | Directory Open Access Journal |
| issn | 1976-1317 |
| language | English |
| last_indexed | 2024-04-10T06:21:34Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Nursing Research |
| spelling | doaj.art-56ed01e6c9464ac69a3853ad2dbe85412023-03-02T04:59:07ZengElsevierAsian Nursing Research1976-13172023-02-011711522Early Sedation Depth and Clinical Outcomes in Mechanically Ventilated Patients in a Hospital: Retrospective Cohort StudyJeong Mi Hwang0Su Jung Choi1Department of Nursing, Samsung Medical Center, Republic of KoreaGraduate School of Clinical Nursing Science, Sungkyunkwan University, Republic of Korea; Correspondence to:sum mary: Purpose: This study aimed to identify the early sedation depth in the first 48 hours of mechanical ventilation and its relationship to clinical outcomes to promote the transition to light sedation. Methods: This retrospective single-center cohort study was conducted in two medical intensive care units (MICUs) at a general tertiary hospital, using a standardized sedation protocol. To investigate the early sedation depth, the Sedation Index was used, which can indicate changes over the first 48 hours. Patients were divided into three groups based on tertiles of Sedation Index. The primary outcome was mortality at 30, 90, and 180 days. The secondary outcomes included length of stay in the ICU and ventilator-free days. Kaplan-Meier analysis and multivariable Cox regression were conducted to compare factors influencing mortality. Results: This study included 394 patients. The deepest sedation group showed more severe illness, delirium, and deeper sedation at admission (p < .001). The survival curve decreased as sedation increased, even within the light sedation levels. In the deepest sedation group, 30-day mortality (hazard ratio [HR] 2.11, 95% confidence interval [CI] 1.33–3.34), 90-day mortality (HR 2.00, 95% CI 1.31–3.06), and 180-day mortality (HR 1.77, 95% CI 1.17–2.67) increased. The length of stay in the ICU and ventilator-free days did not show statistical differences. Conclusions: These results indicate that early deep sedation is a modifiable factor that can potentially affect mortality. The protocol for inducing the transition into light sedation must comply with recommendations to improve clinical outcomes.http://www.sciencedirect.com/science/article/pii/S1976131722000718deep sedationintensive care unitsmortality |
| spellingShingle | Jeong Mi Hwang Su Jung Choi Early Sedation Depth and Clinical Outcomes in Mechanically Ventilated Patients in a Hospital: Retrospective Cohort Study Asian Nursing Research deep sedation intensive care units mortality |
| title | Early Sedation Depth and Clinical Outcomes in Mechanically Ventilated Patients in a Hospital: Retrospective Cohort Study |
| title_full | Early Sedation Depth and Clinical Outcomes in Mechanically Ventilated Patients in a Hospital: Retrospective Cohort Study |
| title_fullStr | Early Sedation Depth and Clinical Outcomes in Mechanically Ventilated Patients in a Hospital: Retrospective Cohort Study |
| title_full_unstemmed | Early Sedation Depth and Clinical Outcomes in Mechanically Ventilated Patients in a Hospital: Retrospective Cohort Study |
| title_short | Early Sedation Depth and Clinical Outcomes in Mechanically Ventilated Patients in a Hospital: Retrospective Cohort Study |
| title_sort | early sedation depth and clinical outcomes in mechanically ventilated patients in a hospital retrospective cohort study |
| topic | deep sedation intensive care units mortality |
| url | http://www.sciencedirect.com/science/article/pii/S1976131722000718 |
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