Early deep-to-light sedation versus continuous light sedation for ICU patients with mechanical ventilation: a cohort study

Jiayue Xu; Qiao He; Mingqi Wang; Zichen Wang; Wenkai Wu; Lingling Li; Wen Wang; Xin Sun

doi:10.1016/j.accpm.2024.101441

Early deep-to-light sedation versus continuous light sedation for ICU patients with mechanical ventilation: a cohort study

Anaesth Crit Care Pain Med. 2024 Oct 10:101441. doi: 10.1016/j.accpm.2024.101441. Online ahead of print.

Authors

Jiayue Xu¹, Qiao He¹, Mingqi Wang¹, Zichen Wang¹, Wenkai Wu¹, Lingling Li², Wen Wang³, Xin Sun⁴

Affiliations

¹ Intensive Care Unit, Chinese Evidence-based Medicine and Cochrane China Center, West China Hospital, Sichuan University, Chengdu 610041, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China; Sichuan Center of Technology Innovation for Real World Data, Chengdu, China.
² Information Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
³ Intensive Care Unit, Chinese Evidence-based Medicine and Cochrane China Center, West China Hospital, Sichuan University, Chengdu 610041, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China; Sichuan Center of Technology Innovation for Real World Data, Chengdu, China. Electronic address: wangwen83@outlook.com.
⁴ Intensive Care Unit, Chinese Evidence-based Medicine and Cochrane China Center, West China Hospital, Sichuan University, Chengdu 610041, China; NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, 610041, China; Sichuan Center of Technology Innovation for Real World Data, Chengdu, China. Electronic address: sunxin@wchscu.cn.

PMID: 39395660
DOI: 10.1016/j.accpm.2024.101441

Abstract

Background: Sedation strategies have not been well established for patients being treated with invasive mechanical ventilation (MV). This study aimed to compare the potential effects of alternative sedation strategies - including early deep-to-light sedation (DTLS), continuous deep sedation (CDS) and continuous light sedation (CLS, the currently recommended strategy) - on ventilator, intensive care unit (ICU) or hospital mortality.

Methods: A cohort study was conducted using two large validated ICU databases, including the Registry of Healthcare-associated Infections in ICUs in China (ICU-HAI) and the Medical Information Mart for Intensive Care (MIMIC). Patients who received MV for more than 3 days with one of three sedation strategies were included. Multivariable survival analyses with inverse probability-weighted competing risk models were conducted separately for ICU-HAI and MIMIC cohorts. Adjusted estimates were pooled using fixed-effects models.

Results: In total, 6700 patients (2627 ICU-HAI, 4073 MIMIC) were included in the cohort study, of whom 2689 received CLS, 2079 CDS and 1932 DTLS. Compared to CLS, DTLS was associated with lower ICU mortality (9.3% vs. 11.0%; pooled adjusted HR 0.78, 95% CI 0.66-0.94) and hospital mortality (16.0% vs. 14.1%; 0.86, CI 0.74-1.00); and CDS was associated with higher ventilator mortality (32.8% vs. 7.0%; 4.65, 3.91-5.53), ICU mortality (40.6% vs. 11.0%; 3.39, 2.95-3.90) and hospital mortality (46.8% vs. 14.1%; 3.27, 2.89-3.71) than CLS. All HRs were qualitatively consistent in both cohorts.

Conclusions: Compared to the continuous light sedation, early deep-to-light sedation strategy was associated with improved patient outcomes, and continuous deep sedation was confirmed with poorer patient outcomes.

Keywords: Critical care; Dynamic sedation protocol; Mechanical ventilation; Mortality.