Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 724 - 731 |
| Number of pages | 8 |
| Journal | American Journal of Respiratory and Critical Care Medicine |
| Volume | 186 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - 2012 |
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Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. / Shehabi, Yahya; Bellomo, Rinaldo; Reade, Michael C; Bailey, Michael John; Bass, Frances; Howe, Belinda Duval; McArthur, Colin; Seppelt, Ian M; Webb, Steve A R; Weisbrodt, Leonie.
In: American Journal of Respiratory and Critical Care Medicine, Vol. 186, No. 8, 2012, p. 724 - 731.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Early intensive care sedation predicts long-term mortality in ventilated critically ill patients
AU - Shehabi, Yahya
AU - Bellomo, Rinaldo
AU - Reade, Michael C
AU - Bailey, Michael John
AU - Bass, Frances
AU - Howe, Belinda Duval
AU - McArthur, Colin
AU - Seppelt, Ian M
AU - Webb, Steve A R
AU - Weisbrodt, Leonie
PY - 2012
Y1 - 2012
N2 - Rationale: Choice and intensity of early (first 48 h) sedation may affect short- and long-term outcome. Objectives: To investigate the relationships between early sedation andtime to extubation, delirium,and hospitaland 180-day mortality amongventilated critically ill patients in the intensive care unit (ICU). Methods: Multicenter (25 Australia and New Zealand hospitals) prospective longitudinal (ICU admission to 28 d) cohort study of medical/surgical patients ventilated and sedated 24 hours or more. We assessed administration of sedative agents, ventilation time, sedation depth using Richmond Agitation Sedation Scale (RASS, four hourly), delirium (daily), and hospital and 180-day mortality. We used multivariable Cox regression to quantify relationships between early deep sedation (RASS, 23 to 25) and patients? outcomes. Measurements and Main Results:We studied 251 patients (mean age, 61.7 6 15.9 yr; mean Acute Physiology and Chronic Health Evaluation [APACHE] II score, 20.8 6 7.8), with 21.1 (53) hospital and 25.8 (64) 180-day mortality. Over 2,678 study days, we completed 14,736 RASS assessments. Deep sedation occurred in 191 (76.1 ) patients within 4 hours of commencing ventilation and in 171 (68 ) patients at 48 hours. Delirium occurred in 111 (50.7 ) patients with median (interquartile range) duration of 2 (1?4) days. After adjusting for diagnosis, age, sex, APACHE II, operative, elective, hospital type, early use of vasopressors, and dialysis, early deep sedation was an independent predictor of time to extubation (hazard ratio [HR], 0.90; 95 confidence interval [CI], 0.87?0.94; P , 0.001), hospital death (HR, 1.11; 95 CI, 1.02?1.20; P ? 0.01), and 180-day mortality (HR, 1.08; 95 CI, 1.01?1.16; P ? 0.026) but not delirium occurring after 48 hours (P ? 0.19). Conclusions: Early sedation depth independently predicts delayed extubation and increased mortality, making it a potential target for interventional studies.
AB - Rationale: Choice and intensity of early (first 48 h) sedation may affect short- and long-term outcome. Objectives: To investigate the relationships between early sedation andtime to extubation, delirium,and hospitaland 180-day mortality amongventilated critically ill patients in the intensive care unit (ICU). Methods: Multicenter (25 Australia and New Zealand hospitals) prospective longitudinal (ICU admission to 28 d) cohort study of medical/surgical patients ventilated and sedated 24 hours or more. We assessed administration of sedative agents, ventilation time, sedation depth using Richmond Agitation Sedation Scale (RASS, four hourly), delirium (daily), and hospital and 180-day mortality. We used multivariable Cox regression to quantify relationships between early deep sedation (RASS, 23 to 25) and patients? outcomes. Measurements and Main Results:We studied 251 patients (mean age, 61.7 6 15.9 yr; mean Acute Physiology and Chronic Health Evaluation [APACHE] II score, 20.8 6 7.8), with 21.1 (53) hospital and 25.8 (64) 180-day mortality. Over 2,678 study days, we completed 14,736 RASS assessments. Deep sedation occurred in 191 (76.1 ) patients within 4 hours of commencing ventilation and in 171 (68 ) patients at 48 hours. Delirium occurred in 111 (50.7 ) patients with median (interquartile range) duration of 2 (1?4) days. After adjusting for diagnosis, age, sex, APACHE II, operative, elective, hospital type, early use of vasopressors, and dialysis, early deep sedation was an independent predictor of time to extubation (hazard ratio [HR], 0.90; 95 confidence interval [CI], 0.87?0.94; P , 0.001), hospital death (HR, 1.11; 95 CI, 1.02?1.20; P ? 0.01), and 180-day mortality (HR, 1.08; 95 CI, 1.01?1.16; P ? 0.026) but not delirium occurring after 48 hours (P ? 0.19). Conclusions: Early sedation depth independently predicts delayed extubation and increased mortality, making it a potential target for interventional studies.
UR - http://ajrccm.atsjournals.org/content/186/8/724.full.pdf
U2 - 10.1164/rccm.201203-0522OC
DO - 10.1164/rccm.201203-0522OC
M3 - Article
VL - 186
SP - 724
EP - 731
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
SN - 1073-449X
IS - 8
ER -