The Profile of Early Sedation Depth and Clinical Outcomes of Mechanically Ventilated Patients in Korea
- Author:
Dong-gon HYUN
1
;
Jee Hwan AHN
;
Ha-Yeong GIL
;
Chung Mo NAM
;
Choa YUN
;
Jae-Myeong LEE
;
Jae Hun KIM
;
Dong-Hyun LEE
;
Ki Hoon KIM
;
Dong Jung KIM
;
Sang-Min LEE
;
Ho-Geol RYU
;
Suk-Kyung HONG
;
Jae-Bum KIM
;
Eun Young CHOI
;
JongHyun BAEK
;
Jeoungmin KIM
;
Eun Jin KIM
;
Tae Yun PARK
;
Je Hyeong KIM
;
Sunghoon PARK
;
Chi-Min PARK
;
Won Jai JUNG
;
Nak-Jun CHOI
;
Hang-Jea JANG
;
Su Hwan LEE
;
Young Seok LEE
;
Gee Young SUH
;
Woo-Sung CHOI
;
Keu Sung LEE
;
Hyung Won KIM
;
Young-Gi MIN
;
Seok Jeong LEE
;
Chae-Man LIM
Author Information
- Publication Type:Original Article
- From:Journal of Korean Medical Science 2023;38(19):e141-
- CountryRepublic of Korea
- Language:English
-
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.
