Early deep-to-light sedation versus continuous light sedation for ICU patients with mechanical ventilation: A cohort study

IF 3.7 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine Pub Date : 2024-10-11 DOI:10.1016/j.accpm.2024.101441

Jiayue Xu , Qiao He , Mingqi Wang , Zichen Wang , Wenkai Wu , Li Lingling , Wen Wang , Xin Sun

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引用次数: 0

Abstract

Background

Sedation strategies have not been well established for patients being treated with invasive mechanical ventilation (MV). This study aimed to compare the potential effects of alternative sedation strategies – including early deep-to-light sedation (DTLS), continuous deep sedation (CDS) and continuous light sedation (CLS, the currently recommended strategy) – on ventilator, intensive care unit (ICU) or hospital mortality.

Methods

A cohort study was conducted using two large validated ICU databases, including the Registry of Healthcare-associated Infections in ICUs in China (ICU-HAI) and the Medical Information Mart for Intensive Care (MIMIC). Patients who received MV for more than 3 days with one of three sedation strategies were included. Multivariable survival analyses with inverse probability-weighted competing risk models were conducted separately for ICU-HAI and MIMIC cohorts. Adjusted estimates were pooled using fixed-effects models.

Results

In total, 6700 patients (2627 ICU-HAI, 4073 MIMIC) were included in the cohort study, of whom 2689 received CLS, 2079 CDS and 1932 DTLS. Compared to CLS, DTLS was associated with lower ICU mortality (9.3% vs. 11.0%; pooled adjusted HR 0.78, 95% CI 0.66−0.94) and hospital mortality (16.0% vs. 14.1%; 0.86, CI 0.74–1.00); and CDS was associated with higher ventilator mortality (32.8% vs. 7.0%; 4.65, 3.91–5.53), ICU mortality (40.6% vs. 11.0%; 3.39, 2.95–3.90) and hospital mortality (46.8% vs. 14.1%; 3.27, 2.89–3.71) than CLS. All HRs were qualitatively consistent in both cohorts.

Conclusions

Compared to the continuous light sedation, early deep-to-light sedation strategy was associated with improved patient outcomes, and continuous deep sedation was confirmed with poorer patient outcomes.

查看原文本刊更多论文

对使用机械通气的重症监护病房患者进行早期深轻度镇静与持续轻度镇静：一项队列研究。

背景：对于接受有创机械通气（MV）治疗的患者，镇静策略尚未得到很好的确定。本研究旨在比较其他镇静策略（包括早期深到浅镇静（DTLS）、持续深镇静（CDS）和持续浅镇静（CLS，目前推荐的策略））对呼吸机、重症监护室（ICU）或医院死亡率的潜在影响：利用两个大型有效的 ICU 数据库（包括中国 ICU 医疗相关感染登记（ICU-HAI）和重症监护医学信息中心（MIMIC））开展了一项队列研究。研究纳入了使用三种镇静策略中的一种接受 MV 3 天以上的患者。使用反概率加权竞争风险模型分别对ICU-HAI和MIMIC队列进行了多变量生存分析。使用固定效应模型对调整后的估计值进行汇总：队列研究共纳入了 6700 名患者（2627 名 ICU-HAI，4073 名 MIMIC），其中 2689 名接受了 CLS，2079 名接受了 CDS，1932 名接受了 DTLS。与 CLS 相比，DTLS 与较低的 ICU 死亡率（9.3% 对 11.0%；汇总调整 HR 0.78，95% CI 0.66-0.94）和住院死亡率（16.0% 对 14.1%；0.86，CI 0.74-1.00）相关；而 CDS 与较低的 ICU 死亡率（9.3% 对 11.0%；汇总调整 HR 0.78，95% CI 0.66-0.94）相关。00）；与CLS相比，CDS与更高的呼吸机死亡率（32.8% vs. 7.0%; 4.65, 3.91-5.53）、ICU死亡率（40.6% vs. 11.0%; 3.39, 2.95-3.90）和住院死亡率（46.8% vs. 14.1%; 3.27, 2.89-3.71）相关。所有HRs在两个队列中的定性结果一致：结论：与持续轻度镇静相比，早期深到轻度镇静策略与患者预后改善相关，而持续深度镇静则证实患者预后较差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anaesthesia Critical Care & Pain Medicine ANESTHESIOLOGY-

CiteScore

6.70

自引率

5.50%

发文量

150

审稿时长

18 days

期刊介绍： Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.