Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

Tanaka, Lilian Maria Sobreira; Azevedo, Luciano César Pontes; Park, Marcelo; Schettino, Guilherme; Nassar, Antônio Paulo; Réa-Neto, Álvaro; Tannous, Luana Alves; Souza-Dantas, Vicente Cés de; Torelly, André P.; Lisboa, Thiago; Piras, Cláudio; Carvalho, Frederico Bruzzi de; Maia, Maurício; Giannini, Fabio; Machado, Flávia Ribeiro; Dal‐Pizzol, Felipe; Carvalho, Alexandre; Santos, Ronaldo B.; Tierno, Paulo Fernando Guimarães Morando Marzocchi; Soares, Márcio; Salluh, Jorge I.

doi:10.1186/cc13995

Cited by 131 publications

(98 citation statements)

References 44 publications

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“…[Figure 1] 9 A subsequent Brazilian prospective cohort study similarly associated early deep sedation with increased time on mechanical ventilation, risk of having a tracheostomy, and higher mortality, and furthermore demonstrated that the effects of deep sedation on mortality were independent of severity of ARDS illness. 10 …”

Section: Minimizing Sedationmentioning

confidence: 99%

Limiting sedation for patients with acute respiratory distress syndrome – time to wake up

Shah

Girard²,

Yende³

2017

Current Opinion in Critical Care

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Purpose of Review Critically ill patients with acute respiratory distress syndrome (ARDS) may require sedation in their clinical care. The goals of sedation in ARDS patients are to improve patient comfort and tolerance of supportive and therapeutic measures without contributing to adverse outcomes. This review discusses the current evidence for sedation management in patients with ARDS. Recent Findings Deep sedation strategies should be avoided in the care of patients with ARDS because deep sedation has been associated with increased time on mechanical ventilation, longer ICU and hospital length of stay, and higher mortality in critically ill patients. Adoption of protocol-based, light-sedation strategies are preferred and improve patient outcomes. Although the optimal sedative agent for ARDS patients is unclear, benzodiazepines should be avoided due to associations with oversedation, delirium, prolonged intensive care unit and hospital length of stay, and increased mortality. Minimizing sedation in patients with ARDS facilitates early mobilization and early discharge from the intensive care unit, potentially aiding in recovery from critical illness. Strategies to optimize ventilation in ARDS patients, such as low-tidal volume ventilation and high positive end-expiratory pressure (PEEP) can be employed without deep sedation; however, deep sedation is required if patients receive neuromuscular blockade, which may benefit some ARDS patients. Knowledge gaps persist as to whether or not prone positioning and extracorporeal membrane oxygenation (ECMO) can be tolerated with light sedation. Summary Current evidence supports the use of protocol-based, light-sedation strategies in critically ill patients with ARDS. Further research into sedation management specifically in ARDS populations is needed.

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Section: Minimizing Sedationmentioning

confidence: 99%

Limiting sedation for patients with acute respiratory distress syndrome – time to wake up

Shah

Girard²,

Yende³

2017

Current Opinion in Critical Care

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“…Excessive sedation in ICU patients can have multiple negative effects, including respiratory depression and prolonged duration of mechanical ventilation (9)(10)(11)(12), prolonged ICU and hospital lengths of stay (12), reduced survival (5,6,12), altered gut function (13), reduced ability to mobilize early (14) and increased risk of ICU-acquired muscle weakness (15), increased psychological stress (16), reduced interaction with family and environment, and increased cognitive dysfunction. (17) Restricted mobilization of ICU patients as a result of deep sedation is likely to increase the development of ICU-acquired weakness (18,19), which can have prolonged effects on long-term outcomes.…”

Section: The Harm Of Oversedationmentioning

confidence: 99%

Optimizing sedation in the ICU: the eCASH concept

Vincent¹

2017

Signa Vitae

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Deep sedation is known to be associated with poor long-term outcomes in critically ill patients, including cognitive and psychological complications and increased mortality. Yet many patients still receive high levels of sedation, particularly during the early days of their intensive care unit (ICU) stay. The eCASH (early Comfort using Analgesia, minimal Sedatives and maximal Humane care) concept is a threepronged approach to minimize sedation in ICU patients by ensuring adequate and timely analgesia is received; patient-centred care is encouraged, including communication aids, noise reduction to facilitate good sleep patterns, early mobilization, and family involvement; and, when needed, sedation is targeted to individual needs and regularly reassessed, with patients kept calm, comfortable and able to cooperate.

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“…Deep sedation levels are associated with several negative outcomes, such as increased time on mechanical ventilation, (1) delirium, (2) memory disturbances, (3) and higher mortality in the short (4) and long term. (5) …”

Section: Introductionmentioning

confidence: 99%

Sedation protocols versus daily sedation interruption: a systematic review and meta-analysis

Nassar¹,

Park²

2016

Revista Brasileira De Terapia Intensiva

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ObjectiveThe aim of this study was to systematically review studies that compared a mild target sedation protocol with daily sedation interruption and to perform a meta-analysis with the data presented in these studies.MethodsWe searched Medline, Scopus and Web of Science databases to identify randomized clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The primary outcome was mortality in the intensive care unit.ResultsSeven studies were included, with a total of 892 patients. Mortality in the intensive care unit did not differ between the sedation protocol and daily sedation interruption groups (odds ratio [OR] = 0.81; 95% confidence interval [CI] 0.60 - 1.10; I2 = 0%). Hospital mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay did not differ between the groups either. Sedation protocols were associated with an increase in the number of days free of mechanical ventilation (mean difference = 6.70 days; 95%CI 1.09 - 12.31 days; I2 = 87.2%) and a shorter duration of hospital length of stay (mean difference = -5.05 days, 95%CI -9.98 - -0.11 days; I2 = 69%). There were no differences in regard to accidental extubation, extubation failure and the occurrence of delirium.ConclusionSedation protocols and daily sedation interruption do not appear to differ in regard to the majority of analyzed outcomes. The only differences found were small and had a high degree of heterogeneity.

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Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

Cited by 131 publications

References 44 publications

Limiting sedation for patients with acute respiratory distress syndrome – time to wake up

Limiting sedation for patients with acute respiratory distress syndrome – time to wake up

Optimizing sedation in the ICU: the eCASH concept

Sedation protocols versus daily sedation interruption: a systematic review and meta-analysis

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