Effect of sedation on short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency

doi:10.5847/wjem.j.1920-8642.2015.02.011

Abstract

Abstract:

BACKGROUND: The present study aimed to determine the short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency who had received sedation or no sedation.
METHODS: The data of 91 patients who had received mechanical ventilation in the first 24 hours between November 2008 and October 2009 were retrospectively analyzed. These patients were divided into two groups: a sedation group (n=28) and a non-sedation group (n=63). The patients were also grouped in two groups: deep sedation group and daily interruption and /or light sedation group.
RESULTS: Overall, the 91 patients who had received ventilation ≥48 hours were analyzed. Multivariate analysis demonstrated two independent risk factors for in-hospital death: sequential organ failure assessment score (P=0.019, RR 1.355, 95%CI 1.051-1.747, B=0.304, SE=0.130, Wald=50483) and sedation (P=0.041, RR 5.015, 95%CI 1.072-23.459, B=1.612, SE=0.787, Wald=4.195). Compared with the patients who had received no sedation, those who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and hospital, and an increased in-hospital mortality rate. The Kaplan-Meier method showed that patients who had received sedation had a lower 60-month survival rate than those who had received no sedation (76.7% vs. 88.9%, Log-rank test=3.630, P=0.057). Compared with the patients who had received deep sedation, those who had received daily interruption or light sedation showed a decreased in-hospital mortality rate (57.1% vs. 9.5%, P=0.008). The 60-month survival of the patients who had received deep sedation was significantly lower than that of those who had daily interruption or light sedation (38.1% vs. 90.5%, Log-rank test=6.783, P=0.009).
CONCLUSIONS: Sedation was associated with in-hospital death. The patients who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and in hospital, and an increased in-hospital mortality rate compared with the patients who did not receive sedation. Compared with daily interruption or light sedation, deep sedation increased the in-hospital mortality and decreased the 60-month survival for patients who had received sedation.

Key words: Sedation, Respiratory insufficiency, Prognosis, Critical illness

Xue-zhong Xing, Yong Gao, Hai-jun Wang, Shi-ning Qu, Chu-lin Huang, Hao Zhang, Hao Wang, Qing-ling Xiao, Ke-lin Sun. Effect of sedation on short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency[J]. World Journal of Emergency Medicine, 2015, 6(2): 147-152.

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References 18

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Variables	Alive (n=82)	Dead (n=9)	t/χ²	Pvalue
Age (years)	61.12±13.64	68.22±12.49	-1.493	0.139
Male (n, %)	60 (73.2)	5 (55.6)	1.233	0.267
Type of admission(n, %)			5.160	0.023
Elective	31 (37.8)	0 (0)
Emergency	51 (62.2)	9 (100)
APACHE II score on admission	13.20±5.58	17.11±10.04	-1.150	0.281
SOFA score on admission	3.36±2.50	6.00±2.92	-2.963	0.004
Sepsis (n, %)	28 (34.1)	7 (77.8)	6.523	0.011
Shock (n, %)	22 (26.8)	6 (66.7)	6.042	0.014
Duration of ventilation (days)	5.34±5.84	12.22±12.72	-1.605	0.145
ALI/ARDS (n, %)	20 (24.4)	4 (44.4)	1.680	0.195
Acute kidney injury (n, %)	8 (9.8)	0 (0)	0.963	0.327
Sedation (n, %)			6.042	0.014
No	60 (73.2)	3 (33.3)
Yes	22 (26.8)	6 (66.7)

Variables	Sedation group (n=28)	Non-sedation group (n=63)	t/χ² value	P value
Age (years)	61.6±15.0	61.9±13.1	0.084	0.933
Male (n, %)	20 (71.4)	45 (71.4)	0.000	1.000
Type of admission (n, %)			4.731	0.030
Elective	5 (17.9)	26 (41.3)
Emergency	23 (82.1)	37 (58.7)
APACHE II score on admission	13.82±6.70	13.48±6.01	-0.244	0.808
SOFA score on admission	4.30±2.79	3.33±2.55	-1.596	0.114
Sepsis (n, %)	19 (67.9)	16 (25.4)	14.766	<0.001
Shock (n, %)	9 (32.1)	19 (30.2)	0.036	0.850
Duration of ventilation (days)	8.96±8.17	4.71±6.07	-2.762	0.007
ICU mortality (n, %)	3 (10.7)	3 (4.8)	1.115	0.291
ICU length of stay (days)	11.07±8.25	6.33±6.14	-3.046	0.003
In-hospital mortality (n, %)	6 (21.4)	3 (4.8)	6.042	0.014
Hospital length of stay (days)	33.36±16.13	26.67±12.64	-2.120	0.037

Variables	Deep sedation (n=7)	Daily interruption and/or light sedation (n=21)	t/χ² value	P value
Duration of ventilation (days)	12.86±13.38	7.67±5.42	0.999	0.353
APACHE II score on admission	14.00±5.07	13.76±7.27	0.080	0.937
SOFA score on admission	5.86±3.13	3.75±2.51	1.795	0.085
ICU mortality (n, %)	2 (28.6)	1 (4.8)	3.111	0.078
ICU length of stay (days)	14.71±12.23	9.86±6.38	1.006	0.347
In-hospital mortality (n, %)	4 (57.1)	2 (9.5)	7.071	0.008
Hospital length of stay (days)	42.00±13.87	30.48±16.08	1.693	0.102

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