Takeaway
- This multicenter prospective study of emergency department (ED) sedation practices for ventilated patients found that deep ED sedation often translates into ongoing deep sedation during ICU care.
- Analgesia and sedation depth varied widely and were sometimes inadequate.
Why this matters
- Previous studies have linked early deep sedation to higher mortality and longer ventilator duration and lengths of stay.
- Most trials enroll patients days after intubation.
Key results
- 52.7% of ED patients received deep sedation.
- 28.4% received no analgesia.
- 10.8% received neither sedation nor analgesia.
- Deep vs light ED sedation:
- Deep ICU sedation, day 1: 53.8% vs 20.3% (P<.001).
- Deep ICU sedation, day 2: 33.3% vs 16.9% (P=.001).
- Ventilator-free days: 1.9 more (95% CI, −0.40 to 4.13; P=.11).
- Acute brain dysfunction: 68.4% vs 55.6% (difference, 12.8%; OR, 1.73; 1.10-2.73; P=.02).
Study design
- 15-center prospective cohort ED SEDation (ED-SED) study (n=324).
- For consecutive adult patients who underwent intubation and mechanical ventilation in the ED, authors assessed sedation.
- Outcome: ventilator-free days.
- Funding: US federal grants to researchers.
Limitations
- Causation not established.
- Deep sedation may reflect worse illness.
- Primary outcome was not statistically significant, though effect size was clinically significant.
References
References