A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study

Robert J Stephens; Erin M Evans; Michael J Pajor; Ryan D Pappal; Haley M Egan; Max Wei; Hunter Hayes; Jason A Morris; Nicholas Becker; Brian W Roberts; Marin H Kollef; Nicholas M Mohr; Brian M Fuller

doi:10.1186/s13054-022-04042-9

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A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study

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A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study

Robert J Stephens, Erin M Evans, Michael J Pajor, Ryan D Pappal, Haley M Egan, Max Wei, Hunter Hayes, Jason A Morris, Nicholas Becker, Brian W Roberts, …

Critical care (London, England), Vol.26(1), pp.179-179

06/15/2022

DOI: 10.1186/s13054-022-04042-9

PMCID: PMC9198202

PMID: 35705989

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Abstract

Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes. Dual-center, retrospective cohort study conducted over 6 months (March-August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of - 3 to - 5 or Riker Sedation-Agitation Scale of 1-3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days. 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65-7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19. The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach.

COVID

Emergency department

Deep sedation

Mechanical ventilation

Details

Title: Subtitle: A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study
Creators: Robert J Stephens - Washington University in St. Louis
Erin M Evans - Division of Critical Care, Departments of Emergency Medicine and Anesthesia, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA
Michael J Pajor - Department of Emergency Medicine, Washington University School of Medicine in St. Louis, Campus Box 8054, St. Louis, MO, 63110, USA
Ryan D Pappal - Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
Haley M Egan - University of Iowa
Max Wei - Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
Hunter Hayes - Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
Jason A Morris - Harvard Affiliated Emergency Medicine Residency
Nicholas Becker - Department of Emergency Medicine, Mount Sinai Morningside/West, New York, NY, 10025, USA
Brian W Roberts - Cooper University Hospital
Marin H Kollef - Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
Nicholas M Mohr - University of Iowa
Brian M Fuller - Division of Critical Care, Departments of Anesthesiology and Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
Resource Type: Journal article
Publication Details: Critical care (London, England), Vol.26(1), pp.179-179
DOI: 10.1186/s13054-022-04042-9
PMID: 35705989
PMCID: PMC9198202
NLM abbreviation: Crit Care
ISSN: 1364-8535
eISSN: 1466-609X
Grant note: R34HL150404 / NHLBI NIH HHS
Language: English
Date published: 06/15/2022
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984296141702771

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