ArticleBMJ open2021
Sedation strategy and ICU delirium: a multicentre, population-based propensity score-matched cohort study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Remimazolam versus propofol for postoperative delirium prevention in geriatric surgery: A systematic review and meta-analysis of randomized controlled trials.Aging clinical and experimental research · 2025Pooled it
- Effect of Remimazolam on Postoperative Delirium in Older Adult Patients Undergoing Orthopedic Surgery: A Prospective Randomized Controlled Clinical Trial.Drug design, development and therapy · 2023Trial
- Feasibility of low-dose dexmedetomidine for prevention of postoperative delirium after intracranial operations: a pilot randomized controlled trial.BMC neurology · 2021Trial
- Impact of sedation with propofol and/or sufentanil on short-term outcomes in patients admitted to the intensive care unit: A retrospective study.The Journal of international medical research · 2026Article
- Propofol Use and Delirium in Patients Aged 80 Years and Over: A Retrospective Cohort Study of 9850 ICU Admissions.Drugs & aging · 2026Article
- Incidence, predictors and outcomes of delirium in acute aortic syndrome.Journal of cardiothoracic surgery · 2026Article
- Early goal-directed sedation with dexmedetomidine is associated with lower delirium rate in mechanically ventilated patients.BMC anesthesiology · 2026Article
- Article
- Evaluation of postoperative delirium in cardiac surgery patients with the SDACS screening tool: a multicenter-multiphase study.Perioperative medicine (London, England) · 2025Article
- Sedative exposure and mortality in intracranial hypertensive tuberculous meningitis: a cohort study with propensity-score matching and machine learning analysis.Frontiers in pharmacology · 2025Article
- Risk Factors of Delirium Following Reconstructive Surgery for Head and Neck Tumors: A Retrospective Clinical Trial.Therapeutics and clinical risk management · 2025Article
- Article
- Incidence of Delirium in ICU Patients With and Without COVID-19 in a Costa Rican Hospital.Cureus · 2024Article
- Effect of remimazolam versus propofol anesthesia on postoperative delirium in neurovascular surgery: study protocol for a randomized controlled, non-inferiority trial.Perioperative medicine (London, England) · 2024Article
- Implementing pain, agitation, delirium, and sleep deprivation protocol in critically ill patients: A pilot study on pharmacological interventions.Clinical and translational science · 2024Article
- Phenobarbital versus benzodiazepines in alcohol withdrawal syndrome.Neuropsychopharmacology reports · 2023Article
- Usage of Inhalative Sedative for Sedation and Treatment of Patient with Severe Brain Injury in Germany, a Nationwide Survey.Journal of clinical medicine · 2023Article
- Delirium in elderly patients with COPD combined with respiratory failure undergoing mechanical ventilation: a prospective cohort study.BMC pulmonary medicine · 2022Article
- Effect of midazolam on delirium in critically ill patients: a propensity score analysis.The Journal of international medical research · 2022Article
- Observational
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesWe examined the relationship between dominant sedation strategy, risk of delirium and patient-centred outcomes in adults admitted to intensive care units (ICUs).
designRetrospective propensity-matched cohort study.
settingMechanically ventilated adults (≥ 18 years) admitted to four Canadian hospital medical/surgical ICUs from 2014 to 2016 in Calgary, Alberta, Canada.
participants2837 mechanically ventilated adults (≥ 18 years) requiring admission to a medical/surgical ICU were evaluated for the relationship between sedation strategy and delirium.
interventionsNone. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary exposure was dominant sedation strategy, defined as the sedative infusion, including midazolam, propofol or fentanyl, with the longest duration before the first delirium assessment. The primary outcome was 'ever delirium' identified using the Intensive Care Delirium Screening Checklist. Secondary outcomes included mortality, length of stay (LOS), ventilation duration and days with delirium. The cohort was analysed in two propensity score (patient characteristics and therapies received) matched cohorts (propofol vs fentanyl and propofol vs midazolam).
results2837 patients (60.7% male; median age 57 years (IQR 43-68)) were considered for propensity matching. In propensity score-matched cohorts(propofol vs midazolam, n=712; propofol vs fentanyl, n=1732), the odds of delirium were significantly higher with midazolam (OR 1.46 (95% CI 1.06 to 2.00)) and fentanyl (OR 1.22 (95% CI 1.00 to 1.48)) compared with propofol dominant sedation strategies. Dominant sedation strategy with midazolam and fentanyl were associated with a longer duration of ventilation compared with propofol. Fentanyl was also associated with increased ICU mortality (OR 1.50, 95% CI 1.07 to 2.12)) ICU and hospital LOS compared with a propofol dominant sedation strategy.
conclusionsWe identified a novel association between fentanyl dominant sedation strategies and an increased risk of delirium, a composite outcome of delirium or death, duration of mechanical ventilation, ICU LOS and hospital LOS. Midazolam dominant sedation strategies were associated with increased delirium risk and mechanical ventilation duration.
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