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Title: Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study
Authors: Tanaka, Lilian Maria Sobreira
Azevedo, Luciano Cesar Pontes
Park, Marcelo
Schettino, Guilherme
Nassar, Antonio Paulo
Rea-Neto, Alvaro
Tannous, Luana
Souza-Dantas, Vicente Ces de
Torelly, Andre
Lisboa, Thiago
Piras, Claudio
Carvalho, Frederico Bruzzi
Maia, Marcelo de Oliveira
Giannini, Fabio Poianas
Machado, Flavia Ribeiro [UNIFESP]
Dal-Pizzol, Felipe
Carvalho, Alexandre Guilherme Ribeiro de
Santos, Ronaldo Batista dos
Tierno, Paulo Fernando Guimaraes Morando Marzocchi
Soares, Marcio
Salluh, Jorge Ibrain Figueira
ERICC Study Investigators
Hosp Copa DOr
Hosp Sirio Libanes
Universidade de São Paulo (USP)
Hosp Sao Camilo Pompeia
Hosp Canc I
Pasteur Hosp
Irmandade Santa Casa Misericordia Porto Alegre
Vitoria Apart Hosp
Hosp Mater Dei
Hosp Santa Luzia
Hosp Sao Luiz
Universidade Federal de São Paulo (UNIFESP)
Hosp Sao Jose Criciuma
UDI Hosp
IDOR DOr Inst Res & Educ
Inst Nacl Canc
Issue Date: 1-Jan-2014
Publisher: Biomed Central Ltd
Citation: Critical Care. London: Biomed Central Ltd, v. 18, n. 4, 10 p., 2014.
Abstract: Introduction: Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. the aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV).Methods: A secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality.Results: A total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P = 0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P=0.001) despite similar PaO2/FiO(2) ratios and acute respiratory distress syndrome (ARDS) severity. in a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% Cl, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; Cl 95%, 1.00 to 1.04), severe ARDS (OR 1.44; Cl 95%, 1.09 to 1.91) and deep sedation (OR 2.36; Cl 9596, 1.31 to 4.25) were independently associated with increased hospital mortality.Conclusions: Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.
ISSN: 1466-609X
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