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Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort

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dc.contributor.author Aragon, Romina E.
dc.contributor.author Proano, Alvaro
dc.contributor.author Mongilardi, Nicole
dc.contributor.author de Ferrari, Aldo
dc.contributor.author Herrera, Phabiola
dc.contributor.author Roldan, Rollin
dc.contributor.author Paz, Enrique
dc.contributor.author Jaymez, Amador A.
dc.contributor.author Chirinos, Eduardo
dc.contributor.author Portugal, Jose
dc.contributor.author Quispe, Rocio
dc.contributor.author Brower, Roy G.
dc.contributor.author Checkley, William
dc.date.accessioned 2019-07-04T17:00:23Z
dc.date.available 2019-07-04T17:00:23Z
dc.date.issued 2019
dc.identifier.uri https://hdl.handle.net/20.500.12866/6900
dc.description.abstract OBJECTIVES: We sought to study the association between sedation status, medications (benzodiazepines, opioids, and antipsychotics), and clinical outcomes in a resource-limited setting. DESIGN: A longitudinal study of critically ill participants on mechanical ventilation. SETTING: Five intensive care units (ICUs) in four public hospitals in Lima, Peru. PATIENTS: One thousand six hundred fifty-seven critically ill participants were assessed daily for sedation status during 28 days and vital status by day 90. RESULTS: After excluding data of participants without a Richmond Agitation Sedation Scale score and without sedation, we followed 1338 (81%) participants longitudinally for 18,645 ICU days. Deep sedation was present in 98% of participants at some point of the study and in 12,942 ICU days. Deep sedation was associated with higher mortality (interquartile odds ratio (OR) = 5.42, 4.23-6.95; p < 0.001) and a significant decrease in ventilator (- 7.27; p < 0.001), ICU (- 4.38; p < 0.001), and hospital (- 7.00; p < 0.001) free days. Agitation was also associated with higher mortality (OR = 39.9, 6.53-243, p < 0.001). The most commonly used sedatives were opioids and benzodiazepines (9259 and 8453 patient days respectively), and the latter were associated with a 41% higher mortality in participants with a higher cumulative dose (75th vs 25th percentile, interquartile OR = 1.41, 1.12-1.77; p < 0.01). The overall cumulative dose of benzodiazepines and opioids was high, 774.5 mg and 16.8 g, respectively, by day 7 and by day 28; these doses approximately doubled. Haloperidol was only used in 3% of ICU days; however, the use of it was associated with a 70% lower mortality (interquartile OR = 0.3, 0.22-0.44, p < 0.001). CONCLUSIONS: Deep sedation, agitation, and cumulative dose of benzodiazepines were all independently associated with higher 90-day mortality. Additionally, deep sedation was associated with less ventilator-, ICU-, and hospital-free days. In contrast, haloperidol was associated with lower mortality in our study. en_US
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartofseries Critical Care
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject acute respiratory failure en_US
dc.subject adult en_US
dc.subject agitation en_US
dc.subject anesthesia level en_US
dc.subject APACHE en_US
dc.subject Article en_US
dc.subject artificial ventilation en_US
dc.subject benzodiazepine derivative en_US
dc.subject clinical assessment en_US
dc.subject clinical outcome en_US
dc.subject Clinical outcomes en_US
dc.subject cohort analysis en_US
dc.subject controlled study en_US
dc.subject Critical illness en_US
dc.subject critically ill patient en_US
dc.subject deep sedation en_US
dc.subject dexmedetomidine en_US
dc.subject drug use en_US
dc.subject female en_US
dc.subject Glasgow coma scale en_US
dc.subject haloperidol en_US
dc.subject human en_US
dc.subject intensive care unit en_US
dc.subject length of stay en_US
dc.subject longitudinal study en_US
dc.subject major clinical study en_US
dc.subject male en_US
dc.subject middle aged en_US
dc.subject mortality rate en_US
dc.subject mortality risk en_US
dc.subject multicenter study en_US
dc.subject narcotic analgesic agent en_US
dc.subject observational study en_US
dc.subject Peru en_US
dc.subject prevalence en_US
dc.subject priority journal en_US
dc.subject propofol en_US
dc.subject prospective study en_US
dc.subject public hospital en_US
dc.subject Ramsay Sedation Scale en_US
dc.subject Richmond Agitation Sedation Scale en_US
dc.subject sedation en_US
dc.subject Sedation en_US
dc.subject Sequential Organ Failure Assessment Score en_US
dc.subject ventilated patient en_US
dc.title Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1186/s13054-019-2394-9
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.09
dc.relation.issn 1466-609X


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