Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

Early deep sedation is associated with decreased in-hospital and two-year follow-up survival

Authors: Felix Balzer, Björn Weiß, Oliver Kumpf, Sascha Treskatsch, Claudia Spies, Klaus-Dieter Wernecke, Alexander Krannich, Marc Kastrup

Published in: Critical Care | Issue 1/2015

Login to get access

Abstract

Introduction

There is increasing evidence that deep sedation is detrimental to critically ill patients. The aim of this study was to examine effects of deep sedation during the early period after ICU admission on short- and long-term survival.

Methods

In this observational, matched-pair analysis, patients receiving mechanical ventilation that were admitted to ICUs of a tertiary university hospital in six consecutive years were grouped as either lightly or deeply sedated within the first 48 hours after ICU admission. The Richmond Agitation-Sedation Score (RASS) was used to assess sedation depth (light sedation: −2 to 0; deep: −3 or below). Multivariate Cox regression was conducted to investigate the impact of early deep sedation within the first 48 hours of admission on in-hospital and two-year follow-up survival.

Results

In total, 1,884 patients met inclusion criteria out of which 27.2% (n = 513) were deeply sedated. Deeply sedated patients had longer ventilation times, increased length of stay and higher rates of mortality. Early deep sedation was associated with a hazard ratio of 1.661 (95% CI: 1.074 to 2.567; P = 0.022) for in-hospital survival and 1.866 (95% CI: 1.351 to 2.576; P <0.001) for two-year follow-up survival.

Conclusions

Early deep sedation during the first 48 hours of intensive care treatment was associated with decreased in-hospital and two-year follow-up survival. Since early deep sedation is a modifiable risk factor, this data shows an urgent need for prospective clinical trials focusing on light sedation in the early phase of ICU treatment.
Appendix
Available only for authorised users
Literature
1.
Martin J, Heymann A, Basell K, Baron R, Biniek R, Burkle H, et al. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version. Ger Med Sci. 2010; 8:Doc02.
2.
Sauder P, Andreoletti M, Cambonie G, Capellier G, Feissel M, Gall O, et al. Sedation and analgesia in intensive care (with the exception of new-born babies). French Society of Anesthesia and Resuscitation. French-speaking Resuscitation Society. Ann Fr Anesth Reanim. 2008;27:541–51.CrossRefPubMed
3.
Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263–306.CrossRefPubMed
4.
Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30:119–41.CrossRefPubMed
5.
Sessler CN, Pedram S. Protocolized and target-based sedation and analgesia in the ICU. Crit Care Clin. 2009;25:489–513.CrossRefPubMed
6.
Porhomayon J, Nader ND, El-Solh AA, Hite M, Scott J, Silinskie K. Pre- and post-intervention study to assess the impact of a sedation protocol in critically ill surgical patients. J Surg Res. 2013;184:966–72.CrossRefPubMed
7.
Mansouri P, Javadpour S, Zand F, Ghodsbin F, Sabetian G, Masjedi M, et al. Implementation of a protocol for integrated management of pain, agitation, and delirium can improve clinical outcomes in the intensive care unit: a randomized clinical trial. J Crit Care. 2013;28:918–22.CrossRefPubMed
8.
Patel SB, Kress JP. Sedation and analgesia in the mechanically ventilated patient. Am J Respir Crit Care Med. 2012;185:486–97.CrossRefPubMed
9.
Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008;371:126–34.CrossRefPubMed
10.
Skrobik Y, Ahern S, Leblanc M, Marquis F, Awissi DK, Kavanagh BP. Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates. Anesth Analg. 2010;111:451–63.CrossRefPubMed
11.
Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010;375:475–80.CrossRefPubMed
12.
Mehta S, McCullagh I, Burry L. Current sedation practices: lessons learned from international surveys. Anesthesiol Clin. 2011;29:607–24.CrossRefPubMed
13.
Martin J, Franck M, Sigel S, Weiss M, Spies C. Changes in sedation management in German intensive care units between 2002 and 2006: a national follow-up survey. Crit Care. 2007;11:R124.CrossRefPubMedPubMedCentral
14.
15.
Luetz A, Balzer F, Radtke FM, Jones C, Citerio G, Walder B, et al. Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists. PLoS One. 2014;9:e110935.CrossRefPubMedPubMedCentral
16.
17.
Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, et al. Early goal-directed sedation versus standard sedation in mechanically ventilated critically ill patients: a pilot study. Crit Care Med. 2013;41:1983–91.CrossRefPubMed
18.
Shehabi Y, Botha JA, Boyle MS, Ernest D, Freebairn RC, Jenkins IR, et al. Sedation and delirium in the intensive care unit: an Australian and New Zealand perspective. Anaesth Intensive Care. 2008;36:570–8.CrossRefPubMed
19.
Shehabi Y, Chan L, Kadiman S, Alias A, Ismail WN, Tan MA, et al. Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study. Intensive Care Med. 2013;39:910–8.CrossRefPubMedPubMedCentral
20.
Kox W. Check-up Anästhesiologie Standards Anästhesie, Intensivmedizin, Schmerztherapie, Notfallmedizin ; mit 23 Tabellen, vol. XIX. Berlin: Springer; 2003. p. 586 S.
21.
Spies C, Kox WJ, Kastrup M, Melzer-Gartzke C. SOPs in Intensivmedizin und Notfallmedizin: Alle relevanten Standards und Techniken für die Klinik. 1st ed. Stuttgart: Thieme; 2013. p. 280.
22.
Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J. 2005;47:458–72.CrossRefPubMed
23.
Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29:1370–9.CrossRefPubMed
24.
Team RC. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2013.
25.
Hansen BB, Klopfer SO. Optimal full matching and related designs via network flows. J Comput Graph Stat. 2006;15:609–27.CrossRef
26.
Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med. 2012;186:724–31.CrossRefPubMed
27.
Tanaka LM, Azevedo LC, Park M, Schettino G, Nassar AP, Rea-Neto A, et al. Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study. Crit Care. 2014;18:R156.CrossRefPubMedPubMedCentral
28.
Spies C, Kastrup M, Kerner T, Melzer-Gartzke C, Zielke H, Kox W. SOPs in Intensivmedizin und Notfallmedizin alle relevanten Standards und Techniken für die Klinik. Stuttgart: Thieme; 2013. p. 279 S.
29.
Kastrup M, Nolting MJ, Ahlborn R, Braun JP, Grubitzsch H, Wernecke KD, et al. An electronic tool for visual feedback to monitor the adherence to quality indicators in intensive care medicine. J Int Med Res. 2011;39:2187–200.CrossRefPubMed
30.
Hager DN, Dinglas VD, Subhas S, Rowden AM, Neufeld KJ, Bienvenu OJ, et al. Reducing deep sedation and delirium in acute lung injury patients: a quality improvement project. Crit Care Med. 2013;41:1435–42.CrossRefPubMed
31.
Lonardo NW, Mone MC, Nirula R, Kimball EJ, Ludwig K, Zhou X, et al. Propofol is associated with favorable outcomes compared with benzodiazepines in ventilated intensive care unit patients. Am J Respir Crit Care Med. 2014;189:1383–94.CrossRefPubMed
Metadata
Title
Early deep sedation is associated with decreased in-hospital and two-year follow-up survival
Authors
Felix Balzer
Björn Weiß
Oliver Kumpf
Sascha Treskatsch
Claudia Spies
Klaus-Dieter Wernecke
Alexander Krannich
Marc Kastrup
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-0929-2

Other articles of this Issue 1/2015

Critical Care 1/2015 Go to the issue

Research

Long-term quality of life in critically ill patients with acute kidney injury treated with renal replacement therapy: a matched cohort study

Research

Plasma fractalkine is a sustained marker of disease severity and outcome in sepsis patients

Research

Influence of a strict glucose protocol on serum potassium and glucose concentrations and their association with mortality in intensive care patients

Review

Use of ultrasound guidance to improve the safety of percutaneous dilatational tracheostomy: a literature review

Letter

Predicting acute kidney injury in severe trauma. A biomarker breakthrough?

Research

Do alcohol use disorders impact on long term outcomes from intensive care?