Early deep sedation is associated with decreased in-hospital and two-year follow-up survival.
BACKGROUND
There is increasing evidence that deep sedation is detrimental to critically ill patients. The aim of this study was to examine effects of deep sedation during the early period after ICU admission on short- and long-term survival.


METHODS
In this observational, matched-pair analysis, patients receiving mechanical ventilation that were admitted to ICUs of a tertiary university hospital in six consecutive years were grouped as either lightly or deeply sedated within the first 48 hours after ICU admission. The Richmond Agitation-Sedation Score (RASS) was used to assess sedation depth (light sedation: -2 to 0; deep: -3 or below). Multivariate Cox regression was conducted to investigate the impact of early deep sedation within the first 48 hours of admission on in-hospital and two-year follow-up survival.


RESULTS
In total, 1,884 patients met inclusion criteria out of which 27.2% (n = 513) were deeply sedated. Deeply sedated patients had longer ventilation times, increased length of stay and higher rates of mortality. Early deep sedation was associated with a hazard ratio of 1.661 (95% CI: 1.074 to 2.567; P = 0.022) for in-hospital survival and 1.866 (95% CI: 1.351 to 2.576; P < 0.001) for two-year follow-up survival.


CONCLUSIONS
Early deep sedation during the first 48 hours of intensive care treatment was associated with decreased in-hospital and two-year follow-up survival. Since early deep sedation is a modifiable risk factor, this data shows an urgent need for prospective clinical trials focusing on light sedation in the early phase of ICU treatment.
Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany. felix.balzer@charite.de.
Felix
F
Balzer
Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany. bjoern.weiss@charite.de.
Björn
B
Weiß
Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany. oliver.kumpf@charite.de.
Oliver
O
Kumpf
Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany. sascha.treskatsch@charite.de.
Sascha
S
Treskatsch
Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany. claudia.spies@charite.de.
Claudia
C
Spies
Charité - Universitätsmedizin Berlin and SOSTANA GmbH, Wildensteiner Straße 27, Berlin, 10318, Germany. wernecke@sostana.de.
Klaus-Dieter
KD
Wernecke
Coordination Centre for Clinical Trials, Department of Biostatistics, Charité -Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany. alexander.krannich@charite.de.
Alexander
A
Krannich
Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany. marc.kastrup@charite.de.
Marc
M
Kastrup
D000368:Aged; D054810:Deep Sedation / Q000401:mortality / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012121:Respiration, Artificial / Q000401:mortality / Q000639:trends*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors