The ED-SED Study: A Multicenter, Prospective Cohort Study of Practice Patterns and Clinical Outcomes Associated With Emergency Department SEDation for Mechanically Ventilated Patients
The ED-SED Study: A Multicenter, Prospective Cohort Study of Practice Patterns and Clinical Outcomes Associated With Emergency Department SEDation for Mechanically Ventilated Patients
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DOI：
10.1097/ccm.0000000000003928
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发表时间：
2019-11-01
影响因子：
8.8
通讯作者：
Avidan, Michael S.
中科院分区：
文献类型：
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作者：
Fuller, Brian M.;Roberts, Brian W.;Avidan, Michael S.
目的：描述急诊科机械通气患者的镇静实践，并检验急诊科深度镇静与不良结局相关的假设。设计：多中心、前瞻性队列研究。单位：15个医学中心的急诊科和ICU。患者：机械通气的成人急诊科患者。干预措施：无。测量和主要结果：记录所有涉及镇静（药物、监测）的数据。深度镇静定义为里士满躁动-镇静评分为-3至-5或镇静-躁动评分为2或1。共有324名患者参加了研究。在171例患者（52.8%）中观察到急诊科深度镇静，与轻度镇静相比，第1天（53.8% vs 20.3%; p < 0.001）和第2天（33.3% vs 16.9%; p = 0.001）ICU深度镇静的频率较高。急诊科深度镇静组的平均（sd）无呼吸机天数为18.1（10.8），轻度镇静组为20.0（9.8）（平均差异，1.9; 95% CI，-0.40至4.13）。根据急诊科镇静深度，无ICU天数（平均差异，1.6; 95% CI，-0.54至3.83）和无住院天数（平均差异，2.3; 95% CI，0.26-4.32）的结果相似。深度镇静组的死亡率为21.1%，轻度镇静组为17.0%（组间差异为4.1%;比值比为1.30; 0.74-2.28）。深度镇静组和轻度镇静组的急性脑功能障碍（谵妄和昏迷）发生率分别为68.4%和55.6%（组间差异，12.8%;比值比，1.73; 1.10-2.73）。结论：早期深度镇静在急诊科是常见的，会延续到ICU，并可能与更差的结局相关。急诊科的镇静实践及其与临床结局的关系需要进一步研究。
Objectives: To characterize emergency department sedation practices in mechanically ventilated patients, and test the hypothesis that deep sedation in the emergency department is associated with worse outcomes. Design: Multicenter, prospective cohort study. Setting: The emergency department and ICUs of 15 medical centers. Patients: Mechanically ventilated adult emergency department patients. Interventions: None. Measurements and Main Results: All data involving sedation (medications, monitoring) were recorded. Deep sedation was defined as Richmond Agitation-Sedation Scale of -3 to -5 or Sedation-Agitation Scale of 2 or 1. A total of 324 patients were studied. Emergency department deep sedation was observed in 171 patients (52.8%), and was associated with a higher frequency of deep sedation in the ICU on day 1 (53.8% vs 20.3%; p < 0.001) and day 2 (33.3% vs 16.9%; p = 0.001), when compared to light sedation. Mean (sd) ventilator-free days were 18.1 (10.8) in the emergency department deep sedation group compared to 20.0 (9.8) in the light sedation group (mean difference, 1.9; 95% CI, -0.40 to 4.13). Similar results according to emergency department sedation depth existed for ICU-free days (mean difference, 1.6; 95% CI, -0.54 to 3.83) and hospital-free days (mean difference, 2.3; 95% CI, 0.26-4.32). Mortality was 21.1% in the deep sedation group and 17.0% in the light sedation group (between-group difference, 4.1%; odds ratio, 1.30; 0.74-2.28). The occurrence rate of acute brain dysfunction (delirium and coma) was 68.4% in the deep sedation group and 55.6% in the light sedation group (between-group difference, 12.8%; odds ratio, 1.73; 1.10-2.73). Conclusions: Early deep sedation in the emergency department is common, carries over into the ICU, and may be associated with worse outcomes. Sedation practice in the emergency department and its association with clinical outcomes is in need of further investigation.