The ED-SED Study: A Multicenter, Prospective Cohort Study of Practice Patterns and Clinical Outcomes Associated With Emergency Department SEDation for Mechanically Ventilated Patients

Brian M Fuller; Brian W Roberts; Nicholas M Mohr; William A Knight IV; Opeolu Adeoye; Ryan D Pappal; Stacy Marshall; Robert Alunday; Matthew Dettmer; Munish Goyal; Colin Gibson; Brian J Levine; Jayna M Gardner-Gray; Jarrod Mosier; James Dargin; Fraser Mackay; Nicholas J Johnson; Sharukh Lokhandwala; Catherine L Hough; Joseph E Tonna; Rachel Tsolinas; Frederick Lin; Zaffer A Qasim; Carrie E Harvey; Benjamin Bassin; Robert J Stephens; Yan Yan; Christopher R Carpenter; Marin H Kollef; Michael S Avidan

doi:10.1097/CCM.0000000000003928

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The ED-SED Study: A Multicenter, Prospective Cohort Study of Practice Patterns and Clinical Outcomes Associated With Emergency Department SEDation for Mechanically Ventilated Patients

Journal article

Peer reviewed

The ED-SED Study: A Multicenter, Prospective Cohort Study of Practice Patterns and Clinical Outcomes Associated With Emergency Department SEDation for Mechanically Ventilated Patients

Brian M Fuller, Brian W Roberts, Nicholas M Mohr, William A Knight IV, Opeolu Adeoye, Ryan D Pappal, Stacy Marshall, Robert Alunday, Matthew Dettmer, Munish Goyal, …

Critical care medicine, Vol.47(11), pp.1539-1548

11/2019

DOI: 10.1097/CCM.0000000000003928

PMCID: PMC7323907

PMID: 31393323

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https://www.ncbi.nlm.nih.gov/pmc/articles/7323907View

Open Access

Abstract

To characterize emergency department sedation practices in mechanically ventilated patients, and test the hypothesis that deep sedation in the emergency department is associated with worse outcomes. Multicenter, prospective cohort study. The emergency department and ICUs of 15 medical centers. Mechanically ventilated adult emergency department patients. None. All data involving sedation (medications, monitoring) were recorded. Deep sedation was defined as Richmond Agitation-Sedation Scale of -3 to -5 or Sedation-Agitation Scale of 2 or 1. A total of 324 patients were studied. Emergency department deep sedation was observed in 171 patients (52.8%), and was associated with a higher frequency of deep sedation in the ICU on day 1 (53.8% vs 20.3%; p < 0.001) and day 2 (33.3% vs 16.9%; p = 0.001), when compared to light sedation. Mean (SD) ventilator-free days were 18.1 (10.8) in the emergency department deep sedation group compared to 20.0 (9.8) in the light sedation group (mean difference, 1.9; 95% CI, -0.40 to 4.13). Similar results according to emergency department sedation depth existed for ICU-free days (mean difference, 1.6; 95% CI, -0.54 to 3.83) and hospital-free days (mean difference, 2.3; 95% CI, 0.26-4.32). Mortality was 21.1% in the deep sedation group and 17.0% in the light sedation group (between-group difference, 4.1%; odds ratio, 1.30; 0.74-2.28). The occurrence rate of acute brain dysfunction (delirium and coma) was 68.4% in the deep sedation group and 55.6% in the light sedation group (between-group difference, 12.8%; odds ratio, 1.73; 1.10-2.73). Early deep sedation in the emergency department is common, carries over into the ICU, and may be associated with worse outcomes. Sedation practice in the emergency department and its association with clinical outcomes is in need of further investigation.

Cohort Studies

Coma - epidemiology

Deep Sedation - mortality

Deep Sedation - statistics & numerical data

Delirium - epidemiology

Emergency Service, Hospital

Female

Hospital Mortality

Humans

Hypnotics and Sedatives - therapeutic use

Intensive Care Units

Male

Middle Aged

Respiration, Artificial - statistics & numerical data

Severity of Illness Index

United States - epidemiology

Details

Title: Subtitle: The ED-SED Study: A Multicenter, Prospective Cohort Study of Practice Patterns and Clinical Outcomes Associated With Emergency Department SEDation for Mechanically Ventilated Patients
Creators: Brian M Fuller - Washington University in St. Louis
Brian W Roberts - Rowan University
Nicholas M Mohr - University of Iowa
William A Knight IV - University of Cincinnati Medical Center
Opeolu Adeoye - University of Cincinnati
Ryan D Pappal - Washington University in St. Louis
Stacy Marshall - Rowan University
Robert Alunday - University of New Mexico
Matthew Dettmer - Cleveland Clinic
Munish Goyal - MedStar Washington Hospital Center
Colin Gibson - Georgetown University
Brian J Levine - Christiana Care Health System
Jayna M Gardner-Gray - Henry Ford Health System
Jarrod Mosier - University of Arizona
James Dargin - Lahey Medical Center
Fraser Mackay - Lahey Medical Center
Nicholas J Johnson - University of Washington
Sharukh Lokhandwala - University of Washington
Catherine L Hough - University of Washington
Joseph E Tonna - University of Utah
Rachel Tsolinas - University of Utah
Frederick Lin - University of Pennsylvania
Zaffer A Qasim - University of Pennsylvania
Carrie E Harvey - University of Michigan
Benjamin Bassin - University of Michigan
Robert J Stephens - Washington University in St. Louis
Yan Yan - Washington University in St. Louis
Christopher R Carpenter - Department of Emergency Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
Marin H Kollef - Washington University in St. Louis
Michael S Avidan - Washington University in St. Louis
Resource Type: Journal article
Publication Details: Critical care medicine, Vol.47(11), pp.1539-1548
DOI: 10.1097/CCM.0000000000003928
PMID: 31393323
PMCID: PMC7323907
NLM abbreviation: Crit Care Med
ISSN: 0090-3493
eISSN: 1530-0293
Grant note: U01 HL123008 / NHLBI NIH HHS UL1 TR000105 / NCATS NIH HHS K23 HL141596 / NHLBI NIH HHS T32 HL007287 / NHLBI NIH HHS UL1 TR002538 / NCATS NIH HHS UL1 TR002345 / NCATS NIH HHS UL1 TR001067 / NCATS NIH HHS UL1 RR025764 / NCRR NIH HHS K23 HL126979 / NHLBI NIH HHS
Language: English
Date published: 11/2019
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
Record Identifier: 9984295937502771

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