Influence of sedation on morbidity and mortality in the intensive care unit.
BACKGROUND
Although 30 to 50% of hospitalized patients in a critical care unit are under sedation, there is sparse data on the impact of sedation on morbidity and case-fatality rates in Brazil. Sedation is associated with higher risks of infection and death rate among patients. However, it is difficult to assess the clinical impact of sedation.


OBJECTIVE
To evaluate the impact of sedation on the incidence of nosocomial infection and all-cause deaths at a critical care unit.


METHODS
Prospective study.


METHODS
Tertiary-care teaching hospital.


METHODS
After the exclusion of patients hospitalized for less than 24 hours, 307 patients were assigned to two groups, considering their states of sedation. After confirmation of heterogeneity in relation to the Acute Physiology and Chronic Health Evaluation (APACHE II) prognostic system, 97 sedated and 97 non-sedated patients were matched in relation to this severity index.


METHODS
Impact of sedation on deep venous thrombosis, incidence of decubital eschars, presence of infection, mortality and length of hospital stay.


RESULTS
There was no difference in the incidence of deep venous thrombosis between the sedated and non-sedated groups, while the frequency of decubital eschars was significantly higher among sedated patients (p = 0.03). Infection was detected in 45.4% of patients under sedation and 21.6% of patients not under sedation (p = 0.006). Mortality for patients that did not receive any kind of sedative was 20.6% and, for those that were sedated during hospitalization, the role was 52.6% (p < 0.0001). The sedated patients had longer hospitalization (11 vs. 4 days) (p < 0.0001).


CONCLUSIONS
We concluded that sedation is associated with higher infection risk and case-fatality rate, and longer hospital stay.
Rodrigues Júnior
Geraldo Rolim
GR
Surgical Care Unit, Department of Surgery, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil. grolim@fmb.unesp.br
do Amaral
José Luiz Gomes
JL
D018806:APACHE; D001938:Brazil / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D015994:Incidence; D007239:Infections / Q000453:epidemiology*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D003668:Pressure Ulcer / Q000453:epidemiology; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000453:epidemiology
D006993:Hypnotics and Sedatives