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[Preprint]. 2022 Mar 1:rs.3.rs-1389892.
doi: 10.21203/rs.3.rs-1389892/v1.

A Dual-Center Cohort Study on The Association Between Early Deep Sedation and Clinical Outcomes in Mechanically Ventilated Patients During the COVID-19 Pandemic: the COVID-SED Study

Robert J Stephens  1 , Erin M Evans  2 , Michael J Pajor  1 , Ryan D Pappal  3 , Haley M Egan  2 , Max Wei  2 , Hunter Hayes  2 , Jason A Morris  4 , Nicholas Becker  5 , Brian W Roberts  6 , Marin H Kollef  3 , Nicholas M Mohr  2 , Brian M Fuller  3
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A Dual-Center Cohort Study on The Association Between Early Deep Sedation and Clinical Outcomes in Mechanically Ventilated Patients During the COVID-19 Pandemic: the COVID-SED Study

Robert J Stephens et al. Res Sq. .

Update in

Abstract

Background : Mechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes. Study Design and Methods : Dual-center, retrospective cohort study conducted over six months (March - August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 hours were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of -3 to -5 or Riker Sedation-Agitation Scale of 1 - 3. To examine impact of early sedation depth on hospital mortality (primary outcome) we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days. Results : 391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation ( p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65 - 7.17; p <0.01). These results were stable in the subgroup of patients with COVID-19. Conclusions : The management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach. Clinical Trial Registration : Not applicable.

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Conflict of interest statement

Competing Interests

All authors report no competing interests

Figures

Figure 1
Figure 1
Study flow diagram
Figure 2
Figure 2
Kaplan-Meier survival curve between the early deep and light sedation groups
See this image and copyright information in PMC

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References

    1. Harhay MO, Wagner J, Ratcliffe SJ, Bronheim RS, Gopal A, Green S, et al. Outcomes and statistical power in adult critical care randomized trials. American journal of respiratory and critical care medicine. 2014;189(12):1469–78. - PMC - PubMed
    1. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical care medicine. 2008;36(8):2238–43. - PubMed
    1. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. New England journal of medicine. 2006;355(26):2725–32. - PubMed
    1. Network ARDS, Wheeler A, Bernard G, Thompson B, Hayden D, DeBoisblanc B. Comparison of two fluid-management strategies in acute lung injury. N Engl j Med. 2006;354(24):2564–75. - PubMed
    1. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301–8. - PubMed

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