Sedation Intensity in the First 48 Hours of Mechanical Ventilation and 180-Day Mortality: A Multinational Prospective Longitudinal Cohort Study*

Shehabi, Yahya; Bellomo, Rinaldo; Kadiman, Suhaini; Ti, Lian Kah; Howe, Belinda; Reade, Michael C.; Khoo, Tien Meng; Alias, Anita; Wong, Y.; Mukhopadhyay, Amartya; McArthur, Colin; Seppelt, Ian; Webb, Steven A R; Green, Maja; Bailey, Michael

doi:10.1097/ccm.0000000000003071

Cited by 165 publications

(152 citation statements)

References 24 publications

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“…The main information to remember is that the use of sedation increases the risk of delirium; both the depth and kind of sedation are of importance, which has been confirmed by the study carried out by Shehabi et al in 2018 [39]. The study included more than 700 patients and analysed the depth of sedation during the first 48 hours of ICU treatment versus the incidence of delirium, possible early extubation and 180-day mortality.…”

Section: Choice Of Sedation and Development Of Deliriummentioning

confidence: 90%

“…According to the authors, irrespective of other factors, a deeper level of sedation increases the risk of death (HR [95% CI] 1.29 [1. 15-1.46]; P < 0.001) and the risk of delirium (HR [95% CI] 1.25 [1.10-1.43]; P = 0.001) while decreasing the possibility of early extubation (HR [95% CI] 0.80 [0.73-0.87]; P < 0.001) [39]. The authors conclude that, since the depth of sedation is an independent risk factor of death, delirium and delayed extubation in the ICU, the targeted level of sedation to achieve should be a RASS score of 0.…”

Section: Choice Of Sedation and Development Of Deliriummentioning

confidence: 99%

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ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Kotfis

Marra

Ely

2018

Anaesthesiol Intensive Ther

137

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ICU delirium is a common medical problem occurring in patients admitted to the intensive care units (ICUs). Studies have shown that ICU delirium is associated with increased mortality, prolonged hospitalization, prolonged mechanical ventilation, costs and the occurrence of cognitive disoders after discharge from ICU. The tools available for ICU delirium screening and diagnosis are validated tests available for all members if the medical team (physicians, nurses, physiotherapists). Their use for routine patient assessment is recommended by international medical and scientific societies. They have been implemented as Pain, Agitation, Delirium (PAD) Guidelines by the Society of Critical Care Medicine. Apart from monitoring, a strategy of prevention and treatment is recommended, based on non-pharmacological approach (restoration of senses, early mobilization, physiotherapy, improvement in sleep hygiene and family involvement) as well as pharmacological treatment (typical and atypical antipsychotics and dexmedetomidine). In this article, we present the risk factors of ICU delirium, available tools for monitoring, as well as options for prevention and treatment of delirium that can be used to improve care over critically ill patients.

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Section: Choice Of Sedation and Development Of Deliriummentioning

confidence: 90%

Section: Choice Of Sedation and Development Of Deliriummentioning

confidence: 99%

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Kotfis

Marra

Ely

2018

Anaesthesiol Intensive Ther

137

View full text Add to dashboard Cite

show abstract

“…Sedation with γ-aminobutyric acid agonists, for example, is a common risk factor for delirium during critical illness. 40 In the current trial, approximately 90% of the patients received one or more doses of sedatives or analgesics, and the doses of sedatives and offtrial antipsychotic medications and the durations of exposures to those agents were similar in all trial groups. Most patients in the trial had hypoactive delirium, which made it difficult to estimate the effect of antipsychotic medications on Shown are Kaplan-Meier curves of the probability of survival.…”

Section: Discussionmentioning

confidence: 70%

Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness

2019

N Engl J Med

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“…The most important factor may be the difference in sedation levels. Patients in the control group received light sedation according to the current guidelines [10,11,29,30], in the ROSE trial, however, those patients received deep sedation in other previous published studies. It has been reported that deep sedation use in critically ill patients is independently associated with delayed extubation and increased mortality [31].…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular blocking agents for acute respiratory distress syndrome: an updated meta-analysis of randomized controlled trials

et al. 2020

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Backgrounds:The aim of this study is investigating the benefits and harms of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome (ARDS). Methods:We comprehensively searched PubMed, EMBASE, and Cochrane library for randomized controlled trials comparing NMBAs to any other comparator. We pooled data using relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes, with 95% confidence intervals. We assessed the quality of included studies using the Cochrane tool and levels of evidence using the GRADE method.Results: Finally, six RCTs (n = 1557 patients) were eligible for analysis. The results showed NMBAs use was not associated with reduced 28 days mortality (RR 0.78; 95% CI, 0.58 to 1.06; P = 0.11), 90 days mortality (RR, 0.92; 95% CI, 0.81 to 1.04; P = 0.16), and intensive care unit (ICU) mortality (RR, 0.90; 95% CI, 0.79 to 1.03; P = 0.13) in patients with ARDS. However, 21-28 days mortality was slightly lower in patients received NMBAs (RR 0.73; 95% CI, 0.54 to 0.99; P = 0.04; I 2 = 53%). Besides, NMBAs use could improve the PaO 2 /FiO 2 ratio at 48 and 72 h, decrease plateau pressure and PEEP at 72 h. Additionally, NMBAs had no significant effects on days free of ventilation at day 28 (WMD, 0.55; 95% CI, − 0.46 to 1.57; P = 0.29), days not in ICU at day 28 (WMD, 0.12; 95% CI, − 0.85 to 1.08; P = 0.82), ICU-acquired weakness (RR, 1.23; 95% CI, 0.99 to 1.93; P = 0.06). Finally, NMBAs use was associated with a lower risk of barotrauma (RR, 0.55; 95% CI, 0.35 to 0.85; P = 0.007). Conclusion:In patients with respiratory distress syndrome, NMBAs may be beneficial in reverse refractory hypoxemia and may be associated with reduced short-term mortality and incidence of barotrauma. However, there is no significant effects of NMBAs on mid-term and long-term mortality, and further studies are required.

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Sedation Intensity in the First 48 Hours of Mechanical Ventilation and 180-Day Mortality: A Multinational Prospective Longitudinal Cohort Study*

Abstract: Sedation intensity independently, in an ascending relationship, predicted increased risk of death, delirium, and delayed time to extubation. These observations suggest that keeping sedation level equivalent to a Richmond Agitation Sedation Scale 0 is a clinically desirable goal.

Cited by 165 publications

References 24 publications

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

ICU delirium ― a diagnostic and therapeutic challenge in the intensive care unit

Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness

Neuromuscular blocking agents for acute respiratory distress syndrome: an updated meta-analysis of randomized controlled trials

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