title: Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study.
abstract: BACKGROUND
  Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV).
  
  
  METHODS
  A secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality.
  
  
  RESULTS
  A total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P = 0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P = 0.001) despite similar PaO2/FiO2 ratios and acute respiratory distress syndrome (ARDS) severity. In a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% CI, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; CI 95%, 1.00 to 1.04), severe ARDS (OR 1.44; CI 95%, 1.09 to 1.91) and deep sedation (OR 2.36; CI 95%, 1.31 to 4.25) were independently associated with increased hospital mortality.
  
  
  CONCLUSIONS
  Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients.
authors.forename: Lilian Maria Sobreira
authors.initials: LM
authors.lastname: Tanaka
authors.forename: Luciano Cesar Pontes
authors.initials: LC
authors.lastname: Azevedo
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
authors.forename: Guilherme
authors.initials: G
authors.lastname: Schettino
authors.forename: Antonio Paulo
authors.initials: AP
authors.lastname: Nassar
authors.forename: Alvaro
authors.initials: A
authors.lastname: Réa-Neto
authors.forename: Luana
authors.initials: L
authors.lastname: Tannous
authors.forename: Vicente Ces
authors.initials: VC
authors.lastname: de Souza-Dantas
authors.forename: André
authors.initials: A
authors.lastname: Torelly
authors.forename: Thiago
authors.initials: T
authors.lastname: Lisboa
authors.forename: Claudio
authors.initials: C
authors.lastname: Piras
authors.forename: Frederico Bruzzi
authors.initials: FB
authors.lastname: Carvalho
authors.forename: Marcelo de Oliveira
authors.initials: Mde O
authors.lastname: Maia
authors.forename: Fabio Poianas
authors.initials: FP
authors.lastname: Giannini
authors.forename: Flavia Ribeiro
authors.initials: FR
authors.lastname: Machado
authors.forename: Felipe
authors.initials: F
authors.lastname: Dal-Pizzol
authors.forename: Alexandre Guilherme Ribeiro
authors.initials: AG
authors.lastname: de Carvalho
authors.forename: Ronaldo Batista
authors.initials: RB
authors.lastname: dos Santos
authors.forename: Paulo Fernando Guimarães Morando Marzocchi
authors.initials: PF
authors.lastname: Tierno
authors.forename: Marcio
authors.initials: M
authors.lastname: Soares
authors.forename: Jorge Ibrain Figueira
authors.initials: JI
authors.lastname: Salluh
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D054810:Deep Sedation / Q000379:methods / Q000401:mortality* / Q000639:trends*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000401:mortality* / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome