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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article number130
JournalCritical Care
Volume23
Issue number1
DOIs
StatePublished - Apr 17 2019

Keywords

  • Clinical outcomes
  • Critical illness
  • Sedation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort'. Together they form a unique fingerprint.

  • Cite this

    Aragón, R. E., Proaño, A., Mongilardi, N., De Ferrari, A., Herrera, P., Roldan, R., Paz, E., Jaymez, A. A., Chirinos, E., Portugal, J., Quispe, R., Brower, R. G., & Checkley, W. (2019). Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort. Critical Care, 23(1), [130]. https://doi.org/10.1186/s13054-019-2394-9