Influence of sedation on morbidity and mortality in the intensive care unit

Abstract

CONTEXT: Although 30 to 50% of hospitalized patients in a critical care unit are under sedation, there is sparse data on the impact of sedation on morbidity and case-fatality rates in Brazil. Sedation is associated with higher risks of infection and death rate among patients. However, it is difficult to assess the clinical impact of sedation. OBJECTIVE: To evaluate the impact of sedation on the incidence of nosocomial infection and all-cause deaths at a critical care unit. TYPE OF STUDY: Prospective study. SETTING: Tertiary-care teaching hospital. PARTICIPANTS: After the exclusion of patients hospitalized for less than 24 hours, 307 patients were assigned to two groups, considering their states of sedation. After confirmation of heterogeneity in relation to the Acute Physiology and Chronic Health Evaluation (APACHE II) prognostic system, 97 sedated and 97 non-sedated patients were matched in relation to this severity index. MAIN MEASUREMENTS: Impact of sedation on deep venous thrombosis, incidence of decubital eschars, presence of infection, mortality and length of hospital stay. RESULTS: There was no difference in the incidence of deep venous thrombosis between the sedated and non-sedated groups, while the frequency of decubital eschars was significantly higher among sedated patients (p = 0.03). Infection was detected in 45.4% of patients under sedation and 21.6% of patients not under sedation (p = 0.006). Mortality for patients that did not receive any kind of sedative was 20.6% and, for those that were sedated during hospitalization, the rate was 52.6% (p < 0.0001). The sedated patients had longer hospitalization (11 vs. 4 days) (p < 0.0001). CONCLUSION: We concluded that sedation is associated with higher infection risk and case-fatality rate, and longer hospital stay.

SEDLine Monitored Sedation and Recovery for Postoperative Ventilated Recipients of Living Donor Liver Transplantation: A Randomized Controlled Trial

“…Shortened duration of sedation in S group was associated with lower incidence of postoperative drowsiness, nausea and vomiting. There is evidence in literature that increased sedation is associated with higher risk of postoperative complications [18]. Cost has become a matter of increasing concern, in our current study we reported higher costs in R group compared to S group and this could be due to the less hospital stay and sedative used [19].…”

Stroke-Related Early Tracheostomy Versus Prolonged Orotracheal Intubation in Neurocritical Care Trial (SETPOINT)

“…This is a clinically important result, as the hazardous potential of these drugs has been demonstrated in numerous ICU studies. [27][28][29][30][31] This finding might also be reflected in the early TT patients spending less time in a fully controlled ventilation mode, which proposes additional pulmonary and weaning advantages. In any case, this pilot trial, despite its limited power, suggests that the effect size of these secondary outcomes as well as that of the primary outcome ICU-LOS is probably low in our population.…”

Incidência de úlceras por pressão em pacientes de Unidade de Terapia Intensiva Cardiopneumológica

“…Particularly in cardio pulmonology, due to improved diagnostic and therapeutic methods, repair and corrective surgeries have been indicated late in the process or for patients with serious conditions. This has caused a greater number of risky situations, as these procedures are compromised by comorbidities and other pre-existing diseases (6) . The real dimensions of skin injury problems in cardiopulmonary ICU patients has raised the interest of professionals who provide care to these patients.…”

“…Reduced sensory perception caused by anesthetic agents and longer periods of immobility due to the impossibility of patient mobilization during the operation (8) facilitate the development of tissue hypoperfusion areas after cardiopulmonary surgeries. Patients whose sensory perception is impaired, that is, who are not able to detect sensations that indicate the need to change position, are among the most susceptible to PU development (6,(8)(9) . In surgery patients, PU usually appears in the period that includes the surgery up to five days after the exposure to the compression applied in the surgery room, although here it is often unnoticed or described as hyperemia only, (8)(9) .…”

“…In any of these situations, critical patients have interrupted blood flow to the area under pressure, affecting tissue oxygenation and nutrition in that area, with the possibility of ischemia, hypoxia, tissue acidosis, edema and tissue necrosis (8) . Tissue tolerance to pressure and ischemia depends on tissue nature and it is influenced by the ability of the skin and supporting structures to redistribute the pressure applied (6,(8)(9) . Critical determinants for the development of PU have been widely discussed by experts for over 30 years and, every day, new factors are discovered regarding the specificity of each patient and each disease (9) .…”