A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study
Abstract Background Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-06-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-022-04042-9 |
| _version_ | 1818239413957689344 |
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| author | Robert J. Stephens Erin M. Evans Michael J. Pajor Ryan D. Pappal Haley M. Egan Max Wei Hunter Hayes Jason A. Morris Nicholas Becker Brian W. Roberts Marin H. Kollef Nicholas M. Mohr Brian M. Fuller |
| author_facet | Robert J. Stephens Erin M. Evans Michael J. Pajor Ryan D. Pappal Haley M. Egan Max Wei Hunter Hayes Jason A. Morris Nicholas Becker Brian W. Roberts Marin H. Kollef Nicholas M. Mohr Brian M. Fuller |
| author_sort | Robert J. Stephens |
| collection | DOAJ |
| description | Abstract Background Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes. Study design and methods Dual-center, retrospective cohort study conducted over 6 months (March–August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of − 3 to − 5 or Riker Sedation-Agitation Scale of 1–3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days. Results 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65–7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19. Conclusions The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach. |
| first_indexed | 2024-12-12T12:57:10Z |
| format | Article |
| id | doaj.art-e5f446c1230a49ab9b096c461f7c8401 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-12T12:57:10Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-e5f446c1230a49ab9b096c461f7c84012022-12-22T00:23:51ZengBMCCritical Care1364-85352022-06-0126111210.1186/s13054-022-04042-9A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED studyRobert J. Stephens0Erin M. Evans1Michael J. Pajor2Ryan D. Pappal3Haley M. Egan4Max Wei5Hunter Hayes6Jason A. Morris7Nicholas Becker8Brian W. Roberts9Marin H. Kollef10Nicholas M. Mohr11Brian M. Fuller12Department of Emergency Medicine, Washington University School of Medicine in St. LouisDivision of Critical Care, Departments of Emergency Medicine and Anesthesia, Roy J. and Lucille A. Carver College of Medicine, University of IowaDepartment of Emergency Medicine, Washington University School of Medicine in St. LouisWashington University School of Medicine in St. LouisCarver College of Medicine, University of Iowa Hospitals and ClinicsCarver College of Medicine, University of Iowa Hospitals and ClinicsCarver College of Medicine, University of Iowa Hospitals and ClinicsDepartment of Emergency Medicine, Harvard-Affiliated Emergency Medicine ResidencyDepartment of Emergency Medicine, Mount Sinai Morningside/WestDepartment of Emergency Medicine, Cooper University HospitalDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine in St. LouisDivision of Critical Care, Departments of Emergency Medicine and Anesthesia, Roy J. and Lucille A. Carver College of Medicine, University of IowaDivision of Critical Care, Departments of Anesthesiology and Emergency Medicine, Washington University School of Medicine in St. LouisAbstract Background Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes. Study design and methods Dual-center, retrospective cohort study conducted over 6 months (March–August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of − 3 to − 5 or Riker Sedation-Agitation Scale of 1–3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days. Results 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65–7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19. Conclusions The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach.https://doi.org/10.1186/s13054-022-04042-9COVIDDeep sedationEmergency departmentMechanical ventilation |
| spellingShingle | Robert J. Stephens Erin M. Evans Michael J. Pajor Ryan D. Pappal Haley M. Egan Max Wei Hunter Hayes Jason A. Morris Nicholas Becker Brian W. Roberts Marin H. Kollef Nicholas M. Mohr Brian M. Fuller A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study Critical Care COVID Deep sedation Emergency department Mechanical ventilation |
| title | A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study |
| title_full | A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study |
| title_fullStr | A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study |
| title_full_unstemmed | A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study |
| title_short | A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study |
| title_sort | dual center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the covid 19 pandemic the covid sed study |
| topic | COVID Deep sedation Emergency department Mechanical ventilation |
| url | https://doi.org/10.1186/s13054-022-04042-9 |
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