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.

Figures/Tables 6

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References 18

1	Franca SA, Toufen C Jr, Hovnanian AL, Albuquerque AL, Borges ER, Pizzo VR, et al. The epidemiology of acute respiratory failure in hospitalized patients: a Brazilian prospective cohort study. J Crit Care 2011; 26: 330.e1-8.
2	Xing XZ, Gao Y, Wang HJ, Yang QH, Huang CL, Qu SN, et al. Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency. World J Emerg Med 2013; 4:43-47. pmid: 25215091
3	Thille AW, Contou D, Fragnoli C, Córdoba-Izquierdo A, Boissier F, Brun-Buisson C. Non-invasive ventilation for acute hypoxemic respiratory failure: intubation rate and risk factors. Crit Care 2013; 17:R269.
4	Yu KY, Zhao L, Chen Z, Yang M. Noninvasive positive pressure ventilation for the treatment of acute respiratory distress syndrome following esophagectomy for esophageal cancer: a clinical comparative study. J Thorac Dis 2013; 5:777-782. doi: 10.3978/j.issn.2072-1439.2013.09.09 pmid: 24409355
5	Reade MC, Finfer S. Sedation and delirium in the intensive care unit. N Engl J Med 2014; 370:444-454.
6	Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342:1471-1477. doi: 10.1056/NEJM200005183422002 pmid: 10816184
7	Treggiari MM, Romand JA, Yanez ND, Deem SA, Goldberg J, Hudson L, et al. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med 2009; 37:2527-2534. pmid: 19602975
8	Strøm T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 2010; 375:475-480. pmid: 20116842
9	Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. BMJ 1974; 2:656-659.
10	Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31:1250-1256. doi: 10.1097/01.CCM.0000050454.01978.3B pmid: 12682500
11	Xing XZ, Wang HJ, Huang CL, Yang QH, Qu SN, Zhang H, et al. Prognosis of patients with shock receiving vasopressors. World J Emerg Med 2013; 4:59-62.
12	Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11:R31. pmid: 17331245
13	Chinese Society of Critical Care Medicine; Chinese Medical Association. Guidelines for management of acute lung injury/acute respiratory distress syndrome: an evidence-based update by the Chinese Society of Critical Care Medicine (2006). Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2006; 18:706-710. [Article in Chinese] pmid: 17166345
14	Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13:818-829. pmid: 3928249
15	Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996; 22:707-710. doi: 10.1007/BF01709751 pmid: 8844239
16	Burry L, Rose L, McCullagh IJ, Fergusson DA, Ferguson ND, Mehta S. Daily sedation interruption versus no daily sedation interruption for critically ill adult patients requiring invasivemechanical ventilation. Cochrane Database Syst Rev 2014; 7: CD009176. pmid: 32691879
17	Shehabi Y, Bellomo R, Reade MC, Bailey M, Bass F, Howe B, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients. Am J Respir Crit Care Med 2012; 186:724-731.
18	Tanaka LM, Azevedo LC, Park M, Schettino G, Nassar AP, Réa-Neto A, et al. Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study. Crit Care 2014; 18:R156. pmid: 25047960

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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