Early Intensive Care Sedation Predicts Long-Term Mortality in Ventilated Critically Ill Patients
Early Intensive Care Sedation Predicts Long-Term Mortality in Ventilated Critically Ill Patients
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DOI：
10.1164/rccm.201203-0522oc
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发表时间：
2012-10-15
影响因子：
24.7
通讯作者：
Weisbrodt, Leonie
中科院分区：
文献类型：
--
作者：
Shehabi, Yahya;Bellomo, Rinaldo;Weisbrodt, Leonie
选择理由和早期干预的强度（前48小时）镇静可能影响短期和长期outcome.Objectives：探讨早期镇静与拔管时间、谵妄时间、住院时间和重症监护室（ICU）通气危重患者180天死亡率之间的关系。多中心（25家澳大利亚和新西兰医院）前瞻性纵向（入住ICU至28天）队列研究，研究对象为接受通气和镇静治疗24小时或更长时间的内科/外科患者。我们使用里士满激越镇静量表（RASS，每4小时一次）评估镇静剂给药、通气时间、镇静深度、谵妄（每日一次）、住院死亡率和180天死亡率。我们使用多变量考克斯回归来量化早期深度镇静与测量和主要结果：我们研究了251名患者（平均年龄61.7 ± 15.9岁;平均急性生理学和慢性健康评估[APACHE] II评分，20.8 +/-7.8），21.1%（53）住院和25.8%（64）180天死亡。在2，678个研究日中，我们完成了14，736项RASS评估。191例（76.1%）患者在开始通气后4小时内发生深度镇静，171例（68%）患者在48小时内发生深度镇静。111例（50.7%）患者发生谵妄，中位（四分位距）持续时间为2（1 - 4）天。在调整诊断、年龄、性别、APACHE II、手术、择期、医院类型、早期使用血管加压药和透析后，早期深度镇静是拔管时间的独立预测因素（风险比[HR]，0.90; 95%置信区间[CI]，0.87 - 0.94; P <0.001），住院死亡（HR，1.11; 95% CI，1.02 - 1.20; P = 0.01）和180天死亡率（HR，1.08; 95% CI，1.01 - 1.16; P = 0.026），但48小时后未发生谵妄结论：早期镇静深度独立预测延迟拔管和死亡率增加，使其成为干预研究的潜在目标。
Rationale Choice and intensity of early (first 48 h) sedation may affect short- and long-term outcome.Objectives: To investigate the relationships between early sedation and time to extubation, delirium, and hospital and 180-day mortality among ventilated critically ill patients in the intensive care unit (ICU).Methods: Multicenter (25 Australia and New Zealand hospitals) prospective longitudinal (ICU admission to 28 d) cohort study of medical/surgical patients ventilated and sedated 24 hours or more. We assessed administration of sedative agents, ventilation time, sedation depth using Richmond Agitation Sedation Scale (RASS, four hourly), delirium (daily), and hospital and 180-day mortality. We used multivariable Cox regression to quantify relationships between early deep sedation (RASS, -3 to -5) and patients' outcomes.Measurements and Main Results: We studied 251 patients (mean age, 61.7 +/- 15.9 yr; mean Acute Physiology and Chronic Health Evaluation [APACHE] II score, 20.8 +/- 7.8), with 21.1% (53) hospital and 25.8% (64) 180-day mortality. Over 2,678 study days, we completed 14,736 RASS assessments. Deep sedation occurred in 191 (76.1%) patients within 4 hours of commencing ventilation and in 171 (68%) patients at 48 hours. Delirium occurred in 111 (50.7%) patients with median (interquartile range) duration of 2 (1-4) days. After adjusting for diagnosis, age, sex, APACHE II, operative, elective, hospital type, early use of vasopressors, and dialysis, early deep sedation was an independent predictor of time to extubation (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.87-0.94; P < 0.001), hospital death (HR, 1.11; 95% CI, 1.02-1.20; P = 0.01), and 180-day mortality (HR, 1.08; 95% CI, 1.01-1.16; P = 0.026) but not delirium occurring after 48 hours (P = 0.19).Conclusions: Early sedation depth independently predicts delayed extubation and increased mortality, making it a potential target for interventional studies.