Selection strategy for sedation depth in critically ill patients on mechanical ventilation

Longxiang Su,Chun Liu,Fengxiang Chang,Huizhen Jiang,Bo Tang,Lin Han,Xiang Zhou,Na Hong,Yun Long,Weiguo Zhu

doi:10.1186/s12911-021-01452-7

Abstract

BackgroundAnalgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients. From the initial nonsedation programs to deep sedation and then to on-demand sedation, the understanding of sedation therapy continues to deepen. However, according to different patient’s condition, understanding the individual patient’s depth of sedation needs remains unclear.MethodsThe public open source critical illness database Medical Information Mart for Intensive Care III was used in this study. Latent profile analysis was used as a clustering method to classify mechanically ventilated patients based on 36 variables. Principal component analysis dimensionality reduction was used to select the most influential variables. The ROC curve was used to evaluate the classification accuracy of the model.ResultsBased on 36 characteristic variables, we divided patients undergoing mechanical ventilation and sedation and analgesia into two categories with different mortality rates, then further reduced the dimensionality of the data and obtained the 9 variables that had the greatest impact on classification, most of which were ventilator parameters. According to the Richmond-ASS scores, the two phenotypes of patients had different degrees of sedation and analgesia, and the corresponding ventilator parameters were also significantly different. We divided the validation cohort into three different levels of sedation, revealing that patients with high ventilator conditions needed a deeper level of sedation, while patients with low ventilator conditions required reduction in the depth of sedation as soon as possible to promote recovery and avoid reinjury.ConclusionThrough latent profile analysis and dimensionality reduction, we divided patients treated with mechanical ventilation and sedation and analgesia into two categories with different mortalities and obtained 9 variables that had the greatest impact on classification, which revealed that the depth of sedation was limited by the condition of the respiratory system.

Highlights

Analgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients
Through latent profile analysis and dimensionality reduction, we divided patients treated with mechanical ventilation and sedation and analgesia into two categories with different mortalities and obtained 9 variables that
The patients in the MIMIC Medical information mart for intensive care III (III) database who underwent mechanical ventilation therapy and took sedative and analgesic drugs during their Intensive care unit (ICU) stay were selected as the research sample

Summary

Introduction

Analgesia and sedation therapy are commonly used for critically ill patients, especially mechanically ventilated patients. After entering the ICU, the patients suffer obvious discomfort and pain due to the disease itself, such as hypoxia, shock, high fever, and surgery Since they lack a complete understanding of the disease status, treatment plan and prognosis, coupled with the various examinations, treatment measures and noisy medical environments, patients in the ICU can become anxious, irritable, painful and even delirious. This state causes tremendous pressure on the patient’s mental state and leads to changes in the patient’s physiological state, even increasing the burden of related organ functions and worsening the condition in severe cases. And dynamic assessments of the patients’ anxiety, pain, and delirium, the provision of appropriate treatment based on disease state and diagnosis, and the delivery of appropriate analgesic and sedative medications have become the cornerstone for the smooth implementation of all other treatments in the ICU [1,2,3]

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Discussion

Conclusion