Association of early sedation level with patient outcomes in moderate-to-severe acute respiratory distress syndrome: Propensity-score matched analysis

• Published in: Journal of critical care Vol. 71; p. 154118
• Main Authors: Palakshappa, Jessica A., Russell, Gregory B., Gibbs, Kevin W., Kloefkorn, Chad, Hayden, Douglas, Moss, Marc, Hough, Catherine L., Files, D. Clark
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2022; Elsevier Limited
• Subjects: Acute respiratory distress syndrome; Anesthesia; Clinical outcomes; Critical care; Enrollments; Humans; Hypnotics and Sedatives - therapeutic use; Intensive Care Units; Mortality; Patients; Propensity Score; Respiration, Artificial - adverse effects; Respiratory distress syndrome; Respiratory Distress Syndrome - therapy; Sedation; Variables; Ventilators; Acute respiratory distress syndrome; Propensity score; PS; ROSE; RASS; ICU; Sedation; ARDS
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2022.154118

Studies of early depth of sedation in mixed critically ill populations have suggested benefit to light sedation; however, the relationship of early depth of sedation with outcomes in patients with acute respiratory distress syndrome (ARDS) is unknown.
We performed a propensity-score matched analysis of early light sedation (Richmond Agitation Sedation Scale Score, RASS 0 to −1 or equivalent) versus deep sedation (RASS −2 or lower) in patients enrolled in the non-intervention group of The Reevaluation of Systemic Early Neuromuscular Blockade trial. Primary outcome was 90 day mortality. Secondary outcomes included days free of mechanical ventilation, days not in ICU, days not in hospital at day 28.
137 of 486 participants (28.2%) received early light sedation. Vasopressor usage and Apache III scores significantly differed between groups. Prior to matching, 90-day mortality was higher in the early deep sedation (45.3%) compared to light sedation (34.2%) group. In the propensity score matched cohort, there was no difference in 90-day mortality (Odds Ratio (OR) 0.72, 95% CI 0.41, 1.27, p = 0.26) or secondary outcomes between the groups.
We did not find an association between early depth of sedation and clinical outcomes in this cohort of patients with moderate-to-severe ARDS.
•Early depth of sedation may have different impact on outcomes in patients with ARDS.•Sicker ARDS patients more likely to receive deep sedation and have worse outcomes.•After propensity matching, sedation depth not associated with clinical outcomes.•Further work is needed to understand optimal early sedation target in ARDS.