Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

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• 作者：Lilian Maria Sobreira Tanaka (102)
  Luciano Cesar Pontes Azevedo (103) (104)
  Marcelo Park (103) (104)
  Guilherme Schettino (103)
  Antonio Paulo Nassar Jr (105)
  Alvaro R茅a-Neto (106)
  Luana Tannous (106)
  Vicente Ces de Souza-Dantas (107) (108)
  Andr茅 Torelly (109)
  Thiago Lisboa (109)
  Claudio Piras (110)
  Frederico Bruzzi Carvalho (111)
  Marcelo de Oliveira Maia (112)
  Fabio Poianas Giannini (113)
  Flavia Ribeiro Machado (114)
  Felipe Dal-Pizzol (115)
  Alexandre Guilherme Ribeiro de Carvalho (116)
  Ronaldo Batista dos Santos (117)
  Paulo Fernando Guimar茫es Morando Marzocchi Tierno (118)
  Marcio Soares (119) (120)
  Jorge Ibrain Figueira Salluh (119) (120)
  for the ERICC study investigators
  
  102. Hospital Copa D鈥橭r ; Rua Figueiredo de Magalh茫es 875 ; Rio de Janeiro ; 22031-010 ; Brazil
  103. Research and Education Institute ; Hospital S铆rio-Liban锚s ; Rua Cel. Nicolau dos Santos 69 ; S茫o Paulo ; 01308-060 ; Brazil
  104. ICU ; Emergency Medicine Department ; Hospital das Clinicas da Faculdade de Medicina da Universidade de S茫o Paulo ; Av. Eneas Carvalho Aguiar 255 ; S茫o Paulo ; 05403-000 ; Brazil
  105. ICU ; Hospital S茫o Camilo Pompeia ; Av. Pompeia 1178 ; S茫o Paulo ; 05022-000 ; Brazil
  106. CEPETI 鈥?Centro de Estudos e Pesquisas em Terapia Intensiva ; Rua Monte Castelo 366 ; Curitiba ; 82530-200 ; Brazil
  107. ICU ; Instituto Nacional de C芒ncer 鈥?Hospital do C芒ncer I ; Pra莽a Cruz Vermelha 23 ; Rio de Janeiro ; 20230-130 ; Brazil
  108. ICU ; Hospital Pasteur ; Av. Amaro Cavalcanti 495 ; Rio de Janeiro ; 20735-040 ; Brazil
  109. Rede Institucional de Pesquisa e Inova莽茫o em Medicina Intensiva (RIPIMI) ; Irmandade da Santa Casa de Miseric贸rdia de Porto Alegre ; Rua Professor Annes Dias 285 鈥?Centro Hist贸rico ; Porto Alegre ; 90020-090 ; Brazil
  110. ICU ; Vitoria Apart Hospital ; Rodovia BR-101 Norte ; Km 2 ; 38 Boa Vista II ; Serra ; ES ; 29161-900 ; Brazil
  111. ICU ; Hospital Mater Dei ; Rua Gon莽alves Dias 2700 (Bloco I) ; Belo Horizonte ; 30140-093 ; Brazil
  112. ICU ; Hospital Santa Luzia ; SHLS 716 鈥?Conjunto E ; Bras铆lia ; 70390-902 ; Brazil
  113. ICU ; Hospital S茫o Luiz ; Unidade Itaim ; Rua Doutor Alceu de Campos Rodrigues 95 ; S茫o Paulo ; 04544-000 ; Brazil
  114. ICU ; Anesthesiology ; Pain and Intensive Care Department ; Universidade Federal de S茫o Paulo ; Rua Napole茫o de Barros ; 715 6掳 andar ; S茫o Paulo ; 04024-900 ; Brazil
  115. ICU ; Hospital S茫o Jos茅 Crici煤ma ; Rua Coronel Pedro Benedet 630 ; Crici煤ma ; 88801-250 ; Brazil
  116. ICU ; UDI Hospital ; Av Professor Carlos Cunha 2000 ; S茫o Luis ; 65076-820 ; Brazil
  117. ICU ; Hospital Universit谩rio da Universidade de S茫o Paulo ; Av Prof. Lineu Prestes 2565 鈥?Cidade Universit谩ria ; S茫o Paulo ; 05508-000 ; Brazil
  118. ICU ; Surgical Emergency Department ; Hospital das Clinicas da Faculdade de Medicina da Universidade de S茫o Paulo ; Av. Eneas Carvalho Aguiar 255 ; S茫o Paulo ; 05403-000 ; Brazil
  119. IDOR 鈥?D鈥橭r Institute for Research and Education ; Rua Diniz Cordeiro 30 ; Rio de Janeiro ; 22281-100 ; Brazil
  120. Postgraduate Program ; Instituto Nacional de C芒ncer ; 10掳 Andar ; Pra莽a Cruz Vermelha 23 ; Rio de Janeiro ; 20230-130 ; Brazil
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：18
• 期：4
• 全文大小：446 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV). Methods A secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48聽hours of ICU admissions, was performed. Sedation depth was evaluated after 48聽hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality. Results A total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P鈥?鈥?.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P鈥?鈥?.001) despite similar PaO2/FiO2 ratios and acute respiratory distress syndrome (ARDS) severity. In a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% CI, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; CI 95%, 1.00 to 1.04), severe ARDS (OR 1.44; CI 95%, 1.09 to 1.91) and deep sedation (OR 2.36; CI 95%, 1.31 to 4.25) were independently associated with increased hospital mortality. Conclusions Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.