Analgosedation Practices and the Impact of Sedation Depth on Clinical Outcomes Among Patients Requiring Mechanical Ventilation in the ED: A Cohort Study

Robert J Stephens; Enyo Ablordeppey; Anne M Drewry; Christopher Palmer; Brian T Wessman; Nicholas M Mohr; Brian W Roberts; Stephen Y Liang; Marin H Kollef; Brian M Fuller

doi:10.1016/j.chest.2017.05.041

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Analgosedation Practices and the Impact of Sedation Depth on Clinical Outcomes Among Patients Requiring Mechanical Ventilation in the ED: A Cohort Study

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Analgosedation Practices and the Impact of Sedation Depth on Clinical Outcomes Among Patients Requiring Mechanical Ventilation in the ED: A Cohort Study

Robert J Stephens, Enyo Ablordeppey, Anne M Drewry, Christopher Palmer, Brian T Wessman, Nicholas M Mohr, Brian W Roberts, Stephen Y Liang, Marin H Kollef and Brian M Fuller

Chest, Vol.152(5), pp.963-971

11/2017

DOI: 10.1016/j.chest.2017.05.041

PMCID: PMC5812748

PMID: 28645462

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Abstract

Background: Analgesia and sedation are cornerstone therapies for mechanically ventilated patients. Despite data showing that early deep sedation in the ICU influences outcome, this has not been investigated in the ED. Therefore, ED-based sedation practices, and their influence on outcome, remain incompletely defined. This study's objectives were to describe ED sedation practices in mechanically ventilated patients and to test the hypothesis that ED sedation depth is associated with worse outcomes. Methods: This was a cohort study of a prospectively compiled ED registry of adult mechanically ventilated patients at a single academic medical center. Hospital mortality was the primary outcome and hospital-, ICU-, and ventilator-free days were secondary outcomes. A backward stepwise multivariable logistic regression model evaluated the primary outcome as a function of ED sedation depth. Sedation depth was assessed with the Richmond Agitation-Sedation Scale (RASS). Results: Four hundred fourteen patients were studied. In the ED, 354 patients (85.5%) received fentanyl, 254 (61.3%) received midazolam, and 194 (46.9%) received propofol. Deep sedation was observed in 244 patients (64.0%). After adjusting for confounders, a deeper ED RASS was associated with mortality (adjusted OR, 0.77; 95% CI, 0.63-0.94). Conclusions: Early deep sedation is common in mechanically ventilated ED patients and is associated with worse mortality. These data suggest that ED-based sedation is a modifiable variable that could be targeted to improve outcome.

sedation depth

SOFA, Sequential Organ Failure Assessment

RASS, Richmond Agitation-Sedation Scale

mechanical ventilation

Chest Infection

Details

Title: Subtitle: Analgosedation Practices and the Impact of Sedation Depth on Clinical Outcomes Among Patients Requiring Mechanical Ventilation in the ED: A Cohort Study
Creators: Robert J Stephens - Washington University School of Medicine in St. Louis, St. Louis, MO
Enyo Ablordeppey - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington School of Medicine in St. Louis, St. Louis, MO
Anne M Drewry - Department of Anesthesiology, Division of Critical Care Medicine, Washington School of Medicine in St. Louis, St. Louis, MO
Christopher Palmer - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington School of Medicine in St. Louis, St. Louis, MO
Brian T Wessman - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington School of Medicine in St. Louis, St. Louis, MO
Nicholas M Mohr - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA
Brian W Roberts - Department of Emergency Medicine, Cooper University Hospital, Camden, NJ
Stephen Y Liang - Departments of Medicine and Emergency Medicine, Division of Infectious Diseases, Washington School of Medicine in St. Louis, St. Louis, MO
Marin H Kollef - Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington School of Medicine in St. Louis, St. Louis, MO
Brian M Fuller - Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Washington School of Medicine in St. Louis, St. Louis, MO
Resource Type: Journal article
Publication Details: Chest, Vol.152(5), pp.963-971
DOI: 10.1016/j.chest.2017.05.041
PMID: 28645462
PMCID: PMC5812748
NLM abbreviation: Chest
ISSN: 0012-3692
eISSN: 1931-3543
Publisher: American College of Chest Physicians
Language: English
Date published: 11/2017
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984024541002771

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