Non‐sedation—Does it improve health‐related quality of life after critical illness? A 3‐month follow‐up sub‐study of the NONSEDA trial

Abstract

Background Critical illness is associated with severely impaired health‐related quality of life (HRQoL) for years following discharge. The NONSEDA trial was a multicenter randomized trial on non‐sedation versus sedation with a daily wake‐up trial in critically ill, mechanically ventilated patients in Scandinavia. The aim of this sub‐study was to assess the effect of non‐sedation on HRQoL and degree of independence in activities in daily living (ADL) 3 months post‐ICU. Methods All survivors were asked to complete the Medical Outcomes Study Short‐Form 36 questionnaire (SF‐36) and the Barthel Index 3 months post‐ICU. To limit missing data, reminders were sent. If unsuccessful, telephone interviews could be used. Outcomes were the level of HRQoL and ADL‐function in each group. All outcomes were assessed blinded. Results Of the 700 patients included 412 survived to follow‐up. A total of 344 survivors participated (82%). Baseline data were equal between the two groups. Mean SF‐36 scores for the non‐sedated vs sedated patients were as follows: Physical Function 45 vs 40, P = .69, Bodily Pain: 61 vs 52, P = .81, General Health: 50 vs 50, P = .84, Vitality: 42 vs 44, P = .85, Social Function: 75 vs 63, P = .85, Role Emotional: 58 vs 50, P = .82, Mental Health: 70 vs 70, P = .89, Role Physical: 25 vs 28, P = .32, Physical Component Score: 38 vs 37, P = .81, Mental Component Score: 48 vs 46, P = .94, Barthel Index: 20 vs 20, P = .74. Conclusion Randomization to non‐sedation neither improved nor impaired health‐related quality of life or degree of independence in activities in daily living 3 months post‐ICU discharge.

Patients’ experiences of cognitive impairment following critical illness: a scoping review protocol

“…Focus is now on using less or even no sedation during critical illness. 14 This approach is especially prevalent in Denmark and other Nordic countries. 15 Less sedation increases the possibility to interact and communicate with the patient during his or her critical illness and provides the basis for active interventions, such as early mobilisation.…”

“…In recent years, a change of paradigm has occurred within critical care regarding the use of sedation. Focus is now on using less or even no sedation during critical illness 14. This approach is especially prevalent in Denmark and other Nordic countries 15.…”

Patients' experiences of cognitive impairment following critical illness treated in an intensive care unit: A scoping review

“…A paradigm shifts has occurred within the past decades in the ICUs in Denmark and Nordic countries and increased the focus on using less or even no sedation during critical illness, thus facilitating better and earlier communication and mobilisation (Egerod et al, 2013; Olsen et al, 2021). However, non‐sedation in itself has not been found to affect cognitive function 3 months following ICU discharge, even though non‐sedated patients were found to be less delirious (Nedergaard et al, 2020).…”