THE ASSOCIATION BETWEEN COMA, DAYS ON MECHANICAL VENTILATION, AND 28-DAY MORTALITY FOR ADULTS MANAGED WITH ANALGESIA-FIRST SEDATION OR TRADITIONAL SEDATION METHODS

Abstract

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: A recent RCT of 86 adults requiring mechanical ventilation (MV) > 48 hours and continuous sedation compared analgesia-first sedation (AFS), protocolized sedation (PS), and both daily sedation interruption (DSI) and PS and found a lack of difference between the three groups for days free of coma [Richmond Agitation Sedation Score (RASS) <-4] [ AFS (15.1), PS (17.6), PS+DSI (13.4); p=0.01] or mechanical ventilation (24, 24, 24; p=0.62) at 28 days or mortality at 28 days [AFS 30%, PS 21%, PS+DSI 13%; p=0.29]. We sought to evaluate the association between coma and days of mechanical ventilation and mortality at 28 days. METHODS: This post-doc cohort analysis included all 86 patients from the RCT. We adjusted for age, gender, baseline APACHE II score, medical (vs. surgical) admission, daily opioid dose, daily sedative dose, and study allocation (i.e., AFS vs. PS. vs DSI+PS) in each regression model. The level of sedation was assessed using the Richmond Agitation–Sedation Scale (RASS); coma was considered for a RASS − 5. RESULTS: 86 patients were analyzed. The mean age was 65±5 years, 55.8% male, an average APACHE II was 24±8. Eighty-one percent of the admissions were medical vs 29% were surgical admissions. A Regression model analysis demonstrated that coma was independently associated with more days of mechanical ventilation in the 28 days after randomization (1.65 days; 95% CI 1.25–3.07, p=0.02) and greater 28-day mortality rate (OR 5.06; 95% CI 1.2–21.2.7, p=0.03). Coma was associated with a higher likelihood of unsuccessful spontaneous breathing trial (SBT) (OR 0.106; 95% CI 0.01–0.8, p=0.03) and longer hospital length of stay (6.9 days; 95% CI 0.17–13.5, p=0.045). CONCLUSIONS: Coma is independently associated with greater days spent mechanically ventilated and higher 28-day mortality regardless of whether patients are managed with AFS, PS, or both DSI+ PS. CLINICAL IMPLICATIONS: Clinicians should adhere to PADIS guidelines on recommendations for sedation goals and avoid deep sedation or coma whenever clinically appropriate. DISCLOSURES: No relevant relationships by Antonio Beltran, source=Web Response No relevant relationships by John Devlin, source=Web Response No relevant relationships by Quang Le, source=Web Response No relevant relationships by Huan Mark Nguyen, source=Web Response No relevant relationships by Hyunsoon Park, source=Web Response No relevant relationships by Ramy Sidhom, source=Web Response No relevant relationships by Maged Tanios, source=Web Response No relevant relationships by Fady Youssef, source=Web Response