Early deep sedation is associated with decreased in-hospital and two-year follow-up survival.

Felix Balzer,Klaus-Dieter Wernecke,Claudia Spies,Marc Kastrup,Sascha Treskatsch,Alexander Krannich,Björn Weiß,Oliver Kumpf

doi:10.1186/s13054-015-0929-2

Felix Balzer, Klaus-Dieter Wernecke + Show 6 more

Open Access

https://doi.org/10.1186/s13054-015-0929-2

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Journal: Critical Care	Publication Date: Dec 1, 2015
Citations: 140	License type: CC BY 4.0

Affiliation: Charité - Universitätsmedizin Berlin

Abstract

IntroductionThere is increasing evidence that deep sedation is detrimental to critically ill patients. The aim of this study was to examine effects of deep sedation during the early period after ICU admission on short- and long-term survival.MethodsIn this observational, matched-pair analysis, patients receiving mechanical ventilation that were admitted to ICUs of a tertiary university hospital in six consecutive years were grouped as either lightly or deeply sedated within the first 48 hours after ICU admission. The Richmond Agitation-Sedation Score (RASS) was used to assess sedation depth (light sedation: −2 to 0; deep: −3 or below). Multivariate Cox regression was conducted to investigate the impact of early deep sedation within the first 48 hours of admission on in-hospital and two-year follow-up survival.ResultsIn total, 1,884 patients met inclusion criteria out of which 27.2% (n = 513) were deeply sedated. Deeply sedated patients had longer ventilation times, increased length of stay and higher rates of mortality. Early deep sedation was associated with a hazard ratio of 1.661 (95% CI: 1.074 to 2.567; P = 0.022) for in-hospital survival and 1.866 (95% CI: 1.351 to 2.576; P <0.001) for two-year follow-up survival.ConclusionsEarly deep sedation during the first 48 hours of intensive care treatment was associated with decreased in-hospital and two-year follow-up survival. Since early deep sedation is a modifiable risk factor, this data shows an urgent need for prospective clinical trials focusing on light sedation in the early phase of ICU treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0929-2) contains supplementary material, which is available to authorized users.

Highlights

There is increasing evidence that deep sedation is detrimental to critically ill patients
In this observational, matched-pairs analysis, we demonstrated that early deep sedation impairs clinical outcomes as it leads to longer mechanical ventilation and prolonged length of stay (LOS)
Early deep sedation in the first 48 hours of intensive care treatment is associated with increased short- and longterm mortality

Summary

Introduction

There is increasing evidence that deep sedation is detrimental to critically ill patients. If invasive procedures are performed or under special conditions such as increased intracranial pressure, sedation may be required for a limited period of time with a welldefined sedation target [1,6,7,8,9]. There is increasing evidence that protocols targeting sedation to a level that keeps the patients awake and Prospective trials have shown a negative impact of early deep sedation on patient outcome including delayed extubation, prolonged length of stay (LOS) and increased mortality [17,18,19]. In order to validate these findings in a European health care system and to account for ‘real-life’ conditions away from study protocols, this study investigated the impact of early deep sedation within the first 48 hours of intensive care by means of a retrospective design. As the term of deep sedation is not clearly defined in the literature, we supplied a statistically robust definition via a two-step approach

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