J Korean Med Sci.  2023 May;38(19):e141. 10.3346/jkms.2023.38.e141.

The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea

• Hyun Dg
• Ahn JH
• Gil HY
• Nam CM
• Yun C
• Lee JM
• Kim JH
• Lee DH
• Kim KH
• Kim DJ
• Lee SM
• Ryu HG
• Hong SK
• Kim JB
• Choi EY
• Baek J
• Kim J
• Kim EJ
• Park TY
• Kim JH
• Park S
• Park CM
• Jung WJ
• Choi NJ
• Jang HJ
• Lee SH
• Lee YS
• Suh GY
• Choi WS
• Lee KS
• Kim HW
• Min YG
• Lee SJ
• Lim CM

• KMID: 2542392
• DOI: http://doi.org/10.3346/jkms.2023.38.e141

Abstract

Background
Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known.
Methods
From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups.
Results
Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582).
Conclusion
In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.

Keyword

Deep Sedation; Critical Illness; Mortality; Critical Care; Ventilator

Figure

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  Fig. 1 Kaplan-Meier curves for time to event. Red line, patients with light sedation during first 48 hours from admission; Blue line, patients with deep sedation during first 48 hours from admission. (A) Time to extubation. (B) Time to intensive care unit discharge. (C) In-hospital survival.

• 

  Fig. 2 Kaplan-Meier estimates for (A) time to extubation, (B) time to ICU discharge, and (C) in-hospital survival in propensity score matched cohort.

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