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KMID : 0191120230380190141
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Journal of Korean Medical Science
2023 Volume.38 No. 19 p.141 ~ p.141
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The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea
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Hyun Dong-Gon
Ahn Jee-Hwan
Gil Ha-Yeong
Nam Chung-Mo
Yun Cho-A
Lee Jae-Myeong
Kim Jae-Hun
Lee Dong-Hyun
Kim Ki-Hoon
Kim Dong-Jung
Lee Sang-Min
Ryu Ho-Geol
Hong Suk-Kyung
Kim Jae-Bum
Choi Eun-Young
Baek Jong-Hyun
Kim Jeoung-Min
Kim Eun-Jin
Park Tae-Yun
Kim Je-Hyeong
Park Sung-Hoon
Park Chi-Min
Jung Won-Jai
Choi Nak-Jun
Jang Hang-Jea
Lee Su-Hwan
Lee Young-Seok
Suh Gee-Young
Choi Woo-Sung
Lee Keu-Sung
Kim Hyung-Won
Min Young-Gi
Lee Seok-Jeong
Lim Chae-Man
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Abstract
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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 interval [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% CI, 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.
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KEYWORD
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Deep Sedation, Critical Illness, Mortality, Critical Care, Ventilator
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