Association Between Sex and Race and Ethnicity and IV Sedation Use in Patients Receiving Invasive Ventilation

Abstract

Listen

Translate article

BackgroundIntravenous sedation is an important tool for managing invasively ventilated patients, yet excess sedation is harmful, and dosing could be influenced by implicit bias. Research questionWhat is the association between sex, race and ethnicity, and sedation practices? MethodsWe performed a retrospective single-center cohort study of adults receiving invasive ventilation for 24 hours or more using the MIMIC-IV (2008-2019) database from Boston, USA. We used a repeated-measures design (4-hour intervals) to study the association between sex (female, male) or race and ethnicity (Asian, Black, Hispanic, White) and sedation outcomes. Sedation outcomes included sedative use (propofol, benzodiazepine, dexmedetomidine) and minimum sedation score. We categorized sedative use as follows: no sedative, then lowest, second, third, and highest quartiles of sedative dose. We adjusted for covariates with multilevel Bayesian proportional odds modeling and reported odds ratios (OR) with 95% credible intervals (CrI). ResultsWe studied 6,764 patients: 43% female; 3.5% Asian, 12% Black, 4.5% Hispanic and 80% White. Benzodiazepines were administered to 2,334 (36%) patients. Black patients received benzodiazepines less often and at lower doses than White patients (OR for more benzodiazepine 0.66, CrI 0.49-0.92). Propofol was administered to 3,865 (57%) patients. Female patients received propofol less often and at lower doses than male patients (OR for more propofol 0.72, CrI 0.61-0.86). Dexmedetomidine was administered to 1,439 (21%) patients, and use was similar across sex or race and ethnicity. Female patients were less sedated than male patients (OR for deeper sedation 0.71, CrI 0.62 to 0.81), and Black patients were more sedated than White patients (OR for more sedated 1.28, CrI 1.05 to 1.55). InterpretationAmong patients invasively ventilated for at least 24 hours, intravenous sedation and attained sedation levels varied by sex and race and ethnicity. Adherence to sedation guidelines may improve equity in sedation management for critically ill patients.