• Crit Care · Jul 2014

    Multicenter Study

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

    • Lilian Maria Sobreira Tanaka, AzevedoLuciano Cesar PontesLC, Marcelo Park, Guilherme Schettino, Antonio Paulo Nassar, Alvaro Réa-Neto, Luana Tannous, Vicente Ces de Souza-Dantas, André Torelly, Thiago Lisboa, Claudio Piras, Frederico Bruzzi Carvalho, MaiaMarcelo de OliveiraMde O, Fabio Poianas Giannini, Flavia Ribeiro Machado, Felipe Dal-Pizzol, Alexandre Guilherme Ribeiro de Carvalho, Ronaldo Batista dos Santos, Paulo Fernando Guimarães Morando Marzocchi Tierno, Marcio Soares, Jorge Ibrain Figueira Salluh, and ERICC study investigators.
    • Crit Care. 2014 Jul 21; 18 (4): R156.

    IntroductionSedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV).MethodsA secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality.ResultsA total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P = 0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P = 0.001) despite similar PaO2/FiO2 ratios and acute respiratory distress syndrome (ARDS) severity. In a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% CI, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; CI 95%, 1.00 to 1.04), severe ARDS (OR 1.44; CI 95%, 1.09 to 1.91) and deep sedation (OR 2.36; CI 95%, 1.31 to 4.25) were independently associated with increased hospital mortality.ConclusionsEarly deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.

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