@article{8c5bb5f3ab4845169dc06361ee9f6514,
title = "Analgosedation Practices and the Impact of Sedation Depth on Clinical Outcomes Among Patients Requiring Mechanical Ventilation in the ED: A Cohort Study",
abstract = "Background Analgesia and sedation are cornerstone therapies for mechanically ventilated patients. Despite data showing that early deep sedation in the ICU influences outcome, this has not been investigated in the ED. Therefore, ED-based sedation practices, and their influence on outcome, remain incompletely defined. This study's objectives were to describe ED sedation practices in mechanically ventilated patients and to test the hypothesis that ED sedation depth is associated with worse outcomes. Methods This was a cohort study of a prospectively compiled ED registry of adult mechanically ventilated patients at a single academic medical center. Hospital mortality was the primary outcome and hospital-, ICU-, and ventilator-free days were secondary outcomes. A backward stepwise multivariable logistic regression model evaluated the primary outcome as a function of ED sedation depth. Sedation depth was assessed with the Richmond Agitation-Sedation Scale (RASS). Results Four hundred fourteen patients were studied. In the ED, 354 patients (85.5%) received fentanyl, 254 (61.3%) received midazolam, and 194 (46.9%) received propofol. Deep sedation was observed in 244 patients (64.0%). After adjusting for confounders, a deeper ED RASS was associated with mortality (adjusted OR, 0.77; 95% CI, 0.63-0.94). Conclusions Early deep sedation is common in mechanically ventilated ED patients and is associated with worse mortality. These data suggest that ED-based sedation is a modifiable variable that could be targeted to improve outcome.",
keywords = "ED, mechanical ventilation, sedation depth",
author = "Stephens, {Robert J.} and Enyo Ablordeppey and Drewry, {Anne M.} and Christopher Palmer and Wessman, {Brian T.} and Mohr, {Nicholas M.} and Roberts, {Brian W.} and Liang, {Stephen Y.} and Kollef, {Marin H.} and Fuller, {Brian M.}",
note = "Funding Information: Financial/nonfinancial disclosures: The authors have reported to CHEST the following: R. J. S. received funding from Washington University Institute of Clinical and Translational Sciences and from the National Center for Advancing Translational Sciences of the National Institutes of Health. E. A. was supported by the Washington University School of Medicine Faculty Scholars Grant and the Foundation for Barnes-Jewish Hospital. N. M. M. was supported by grant funds from the Health Resources and Services Administration. B. W. R. was supported by a grant from the National Institutes of Health/National Heart, Lung, and Blood Institute. B. M. F. and A. M. D. were funded by the KL2 Career Development Award, and this research was supported by the Washington University Institute of Clinical and Translational Sciences grants from the National Center for Advancing Translational Sciences. B. M. F. was also funded by the Foundation for Barnes-Jewish Hospital Clinical and Translational Sciences Research Program. A. M. D. was also funded by a grant from the Division of Clinical and Translational Research of the Department of Anesthesiology at Washington University School of Medicine. S. Y. L. was supported by the KM1 Comparative Effectiveness Research Career Development Award [Grant No. KM1CA156708-01], the Clinical and Translational Science Award program [Grant No. UL1RR024992] of the National Center for Advancing Translational Sciences, and the Barnes-Jewish Patient Safety & Quality Career Development Program, which is funded by the Foundation for Barnes-Jewish Hospital. M. H. K. was supported by the Foundation for Barnes-Jewish Hospital. None declared (C. P., B. T. W.). Funding Information: FUNDING/SUPPORT: R. J. S. received funding from Washington University Institute of Clinical and Translational Sciences Grant UL1TR000448, subaward TL1TR000449 and from the National Center for Advancing Translational Sciences of the National Institutes of Health. B. W. R. was supported by a grant from the National Institutes of Health/National Heart, Lung, and Blood Institute (K23HL126979). B. M. F. and A. M. D. were funded by the KL2 Career Development Award, and this research was supported by the Washington University Institute of Clinical and Translational Sciences [Grants UL1 TR000448 and KL2 TR000450] from the National Center for Advancing Translational Sciences. B. M. F. was also funded by the Foundation for Barnes-Jewish Hospital Clinical and Translational Sciences Research Program [Grant No. 8041-88]. Publisher Copyright: {\textcopyright} 2017 American College of Chest Physicians",
year = "2017",
month = nov,
doi = "10.1016/j.chest.2017.05.041",
language = "English",
volume = "152",
pages = "963--971",
journal = "CHEST",
issn = "0012-3692",
number = "5",
}