The relationship between over sedation and clinical outcomes of patients under mechanical ventilation: a retrospective cohort study
10.3969/j.issn.1008-9691.2015.05.014
- VernacularTitle:机械通气患者过度镇静与临床预后关系的回顾性队列研究
- Author:
Yunlong WENG
- Publication Type:Journal Article
- Keywords:
Deep sedation;
Critical illness;
Mechanical ventilation;
Mortality
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2015;22(5):508-512
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the effect of over sedation on outcomes of critically ill adult patients under mechanical ventilation (MV) in intensive care unit (ICU).Methods The historical data of 214 adult patients with MV admitted to ICU in Lu'an City Hospital of Anhui Province from January 2009 to November 2014 were retrospectively analyzed. The physiological parameters, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, the dosage and days of vasoactive drugs used, etc were recorded after admission. The main clinical outcome was ICU mortality. According to the situation of sedative usage in 48 hours after patient's admission, the incidence of deep sedation was calculated, the definition of deep sedation being -4 to -5 Richmond agitation-sedation scale (RASS) scores. Multivariate logistic analysis was used to identify whether the patient's unfavorable outcome or mortality was correlated to deep sedation.Results A total of 214 patients were evaluated. Overall ICU mortality was 36.92% (79/214). 114 cases in deep sedation group, 100 cases in mild sedation group. Compared with survival group (135 cases), the patients in death group (79 cases) had older age (years: 60.41±18.68 vs. 53.30±19.05,t = -2.653,P = 0.009), higher APACHE Ⅱ scores (19.20±2.98 vs. 17.50±3.15,t = -3.904,P < 0.001), the higher rate of patients with deep sedation [60.8% (48/79) vs. 38.5% (52/135),χ2 = 9.903,P = 0.002], and the larger dose of norepinephrine used (mg: 62.8±12.4 vs. 34.7±7.5,t = 2.055,P = 0.043). Compared with mild sedation group, the patients in deep sedation group had high rate of non-complication [22.0% (22/100) vs. 10.5% (12/114),χ2 = 5.248,P = 0.022], and higher mortality [48.0% (48/100) vs. 27.2% (31/114),χ2 = 9.903,P = 0.002]. Multivariate logistic analyses showed, older age [odds ratio (OR) =1.020, 95% confidence interval (95%CI) = 1.004 - 1.037,P = 0.016], higher APACHE Ⅱ score (OR = 1.182, 95%CI = 1.070 - 1.305,P = 0.001) and deep sedation (OR = 2.882, 95%CI = 1.543 - 5.382, P = 0.001) were the independent risk factors associated with increased ICU mortality in critically ill patients under MV.Conclusion Deep sedation can increase the mortality of patients under MV in ICU.
