Associations of Race With Sedation Depth Among Mechanically Ventilated Adults: A Retrospective Cohort Study

Abstract

OBJECTIVES: To evaluate the association of race with proportion of time in deep sedation among mechanically ventilated adults. DESIGN: Retrospective cohort study from October 2017 to December 2019. SETTING: Five hospitals within a single health system. PATIENTS: Adult patients who identified race as Black or White who were mechanically ventilated for greater than or equal to 24 hours in one of 12 medical, surgical, cardiovascular, cardiothoracic, or mixed ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The exposure was White compared with Black race. The primary outcome was the proportion of time in deep sedation during the first 48 hours of mechanical ventilation, defined as Richmond Agitation-Sedation Scale values of –3 to –5. For the primary analysis, we performed mixed-effects linear regression models including ICU as a random effect, and adjusting for age, sex, English as preferred language, body mass index, Elixhauser comorbidity index, Laboratory-based Acute Physiology Score, Version 2, ICU admission source, admission for a major surgical procedure, and the presence of septic shock. Of the 3337 included patients, 1242 (37%) identified as Black, 1367 (41%) were female, and 1002 (30%) were admitted to a medical ICU. Black patients spent 48% of the first 48 hours of mechanical ventilation in deep sedation, compared with 43% among White patients in unadjusted analysis. After risk adjustment, Black race was significantly associated with more time in early deep sedation (mean difference, 5%; 95% CI, 2–7%; p < 0.01). CONCLUSIONS: There are disparities in sedation during the first 48 hours of mechanical ventilation between Black and White patients across a diverse set of ICUs. Future work is needed to determine the clinical significance of these findings, given the known poorer outcomes for patients who experience early deep sedation.

Association between sex and race and ethnicity and intravenous sedation use in patients receiving invasive ventilation

“…By contrast, our results are more consistent with a multi-centre retrospective study showing that Black compared to White patients spent more time deeply sedated in the first 48 hours of ICU admission. (15) This study focused on a similar population of mixed medical-surgical ICU patients with at least 24 hours of invasive ventilation. Our findings and these three studies demonstrate that sex and race and ethnicity can be associated with sedation management, even if the associations vary by context.…”

“…(14) In a cohort of patients receiving invasive ventilation, Black compared to White patients had an increased risk of deep sedation in the first 48 hours. (15) Fewer studies have assessed differences in sedation practices between male and female patients.…”