ArticleCritical care (London, England)2022
A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: The COVID-SED study.
Article in Critical care (London, England), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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18 citing papers in PubMed, 38 citations in OpenAlex.
- Barriers and Facilitators to ICU Liberation Bundle Implementation and Compliance.Critical care explorations · 2026Article
- New and persistent psychoactive medication use in intensive care unit survivors with COVID-19: a multicentre population-based cohort study.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026Article
- Sedation practices and associated clinical outcomes among adult ICU patients managed by advanced practice providers versus resident physicians.Journal of critical care · 2026Article
- Management of Mechanical Ventilation in Emergency Medicine: A Scoping Review.Journal of the American College of Emergency Physicians open · 2026Review
- Post-intubation sedation in the emergency department: A scoping review.The American journal of emergency medicine · 2026Article
- Early deep sedation was associated with post-hospital one-year mortality in critically ill surgical patients: a propensity-matched retrospective cohort study.BMC anesthesiology · 2025Article
- How much is too much? A medication use evaluation of VA ICU sedation practice during the COVID-19 pandemic.PloS one · 2025Article
- A Retrospective, Single-Center Assessment of Changes in Pain, Agitation, and Delirium Management Before and During the COVID-19 Pandemic.Critical care explorations · 2025Article
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- Inhaled volatile anesthetics in the intensive care unit.World journal of critical care medicine · 2024Review
- The impact of the COVID-19 pandemic on ICU clinical trials: a description of one research team's experience.Trials · 2023Article
- Management of Coronavirus Disease-2019 Infection in Pregnancy.Emergency medicine clinics of North America · 2023Review
- Are Short-Term Changes in Physiological Variables in ICU Patients as a Result of Physiotherapy of Any Clinical Relevance?Respiratory care · 2023Article
- Perspective from anesthesiologists on the therapy of critically ill patients with COVID-19.Anesthesiology and perioperative science · 2023Article
- Triglyceride Concentrations and Their Relationship to Sedation Choice and Outcomes in Mechanically Ventilated Patients Receiving Propofol.Annals of the American Thoracic Society · 2023Observational
- Characteristics of delirium and its association with sedation and in-hospital mortality in patients with COVID-19 on veno-venous extracorporeal membrane oxygenation.Frontiers in medicine · 2023Article
- Prone Positioning Decreases Inhomogeneity and Improves Dorsal Compliance in Invasively Ventilated Spontaneously Breathing COVID-19 Patients-A Study Using Electrical Impedance Tomography.Diagnostics (Basel, Switzerland) · 2022Article
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13 authors at 6 institutions in 1 country.
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Abstract
backgroundMechanically ventilated patients have experienced greater periods of prolonged deep sedation during the coronavirus disease (COVID-19) pandemic. Multiple studies from the pre-COVID era demonstrate that early deep sedation is associated with worse outcome. Despite this, there is a lack of data on sedation depth and its impact on outcome for mechanically ventilated patients during the COVID-19 pandemic. We sought to characterize the emergency department (ED) and intensive care unit (ICU) sedation practices during the COVID-19 pandemic, and to determine if early deep sedation was associated with worse clinical outcomes. STUDY DESIGN AND
methodsDual-center, retrospective cohort study conducted over 6 months (March-August, 2020), involving consecutive, mechanically ventilated adults. All sedation-related data during the first 48 h were collected. Deep sedation was defined as Richmond Agitation-Sedation Scale of - 3 to - 5 or Riker Sedation-Agitation Scale of 1-3. To examine impact of early sedation depth on hospital mortality (primary outcome), we used a multivariable logistic regression model. Secondary outcomes included ventilator-, ICU-, and hospital-free days.
results391 patients were studied, and 283 (72.4%) experienced early deep sedation. Deeply sedated patients received higher cumulative doses of fentanyl, propofol, midazolam, and ketamine when compared to light sedation. Deep sedation patients experienced fewer ventilator-, ICU-, and hospital-free days, and greater mortality (30.4% versus 11.1%) when compared to light sedation (p < 0.01 for all). After adjusting for confounders, early deep sedation remained significantly associated with higher mortality (adjusted OR 3.44; 95% CI 1.65-7.17; p < 0.01). These results were stable in the subgroup of patients with COVID-19.
conclusionsThe management of sedation for mechanically ventilated patients in the ICU has changed during the COVID pandemic. Early deep sedation is common and independently associated with worse clinical outcomes. A protocol-driven approach to sedation, targeting light sedation as early as possible, should continue to remain the default approach.
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