Early intensive care sedation predicts long-term mortality in ventilated critically ill patients

Yahya Shehabi, Rinaldo Bellomo, Michael C Reade, Michael John Bailey, Frances Bass, Belinda Duval Howe, Colin McArthur, Ian M Seppelt, Steve A R Webb, Leonie Weisbrodt

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Abstract

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.
Original languageEnglish
Pages (from-to)724 - 731
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume186
Issue number8
DOIs
Publication statusPublished - 2012

Cite this

@article{73f2b4a6d9c8401b9ed28151e2dcc888,
title = "Early intensive care sedation predicts long-term mortality in ventilated critically ill patients",
abstract = "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.",
author = "Yahya Shehabi and Rinaldo Bellomo and Reade, {Michael C} and Bailey, {Michael John} and Frances Bass and Howe, {Belinda Duval} and Colin McArthur and Seppelt, {Ian M} and Webb, {Steve A R} and Leonie Weisbrodt",
year = "2012",
doi = "10.1164/rccm.201203-0522OC",
language = "English",
volume = "186",
pages = "724 -- 731",
journal = "American Journal of Respiratory and Critical Care Medicine",
issn = "1073-449X",
publisher = "American Thoracic Society",
number = "8",

}

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 journalArticleResearchpeer-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 -