Early Deep Sedation Practices Worsened During the Pandemic Among Adult Patients Without COVID-19: A Retrospective Cohort Study

Abstract

BackgroundThere is substantial evidence that patients with COVID-19 were treated with sustained deep sedation during the pandemic. However, it is unknown whether such guideline-discordant care had spillover effects to patients without COVID-19. Research QuestionDid patterns of early deep sedation change during the pandemic for mechanically ventilated patients without COVID-19? Study Design and MethodsWe utilized electronic health record data from 4,237 intubated patients without COVID-19. We compared sedation practices in the first 48 hours after intubation across pre-pandemic (2/1/2018-1/31/2020), pandemic (4/1/2020-3/31/2021), and late-pandemic (4/1/2021-3/31/2022) periods. ResultsPatients spent an average of 13.0 hours pre-pandemic deeply sedated in the first 48 hours after intubation. This increased 1.9 hours [95% confidence interval (CI) 1.0-2.8] during the pandemic and 2.9 hours [95% CI 2.0-3.8] in the late-pandemic period. The proportion of patients that spent over half of the first 48 hours deeply sedated was 18.9% pre-pandemic, 22.3% during the pandemic, and 25.9% during the late-pandemic. Ventilator-free days decreased during the pandemic, with a subdistributional hazards ratio of being alive without mechanical ventilation at 28 days of 0.87 [95% CI 0.79-0.95] compared to pre-pandemic. Tracheostomy placement increased during the pandemic, compared to the pre-pandemic (odds ratio 1.41 [95% CI 1.08-1.82]). In the medical intensive care unit, early deep sedation increased 2.5 hours [95% CI 0.6-4.4] during the pandemic and 4.9 hours [95% CI 3.0-6.9] during the late-pandemic, compared to pre-pandemic. InterpretationAmong mechanically ventilated patients without COVID-19, sedation use increased during the pandemic. In the subsequent year, these practices did not return to pre-pandemic standards.